TY - JOUR
T1 - Timing of Androgen Deprivation Therapy and its Impact on Survival After Radical Prostatectomy
T2 - A Matched Cohort Study
AU - Siddiqui, Sameer A.
AU - Boorjian, Stephen A.
AU - Inman, Brant
AU - Bagniewski, Stephanie
AU - Bergstralh, Eric J.
AU - Blute, Michael L.
PY - 2008/5
Y1 - 2008/5
N2 - Purpose: We assessed the impact of the timing of androgen deprivation on disease progression after radical prostatectomy for patients with localized prostate cancer. Materials and Methods: We evaluated all patients who underwent radical prostatectomy between 1990 and 1999. Patients with pathological lymph node negative disease who received androgen deprivation therapy were then separated into 5 groups for analysis based on the time of hormone therapy initiation: 1-adjuvant androgen deprivation, 2-androgen deprivation therapy started at a postoperative prostate specific antigen of 0.4 ng/ml or greater, 3-at prostate specific antigen 1.0 or greater, 4-at prostate specific antigen 2.0 or greater and 5-at systemic progression. The first 4 groups were matched by clinical and pathological features to control groups who did not receive androgen deprivation after surgery using a nested, matched cohort design. Median followup for the entire cohort was 10 years. Clinical end points included systemic progression-free survival and cancer specific survival. Results: After matching clinicopathological variables adjuvant androgen deprivation therapy was associated with improved 10-year systemic progression-free survival (95% vs 90%, p <0.001) and 10-year cancer specific survival (98% vs 95%, p = 0.009), although overall survival for these patients remained unchanged (84% vs 83%, p = 0.427). In contrast, we found that men who started hormonal therapy at a postoperative prostate specific antigen of 0.4 or greater, 1.0 or 2.0 did not have improved systemic progression-free or cancer specific survival. Conclusions: Adjuvant hormonal therapy modestly improves cancer specific survival and systemic progression-free survival after prostatectomy. The benefit of hormone therapy is lost when androgen deprivation is delivered at the time of prostate specific antigen recurrence or systemic progression.
AB - Purpose: We assessed the impact of the timing of androgen deprivation on disease progression after radical prostatectomy for patients with localized prostate cancer. Materials and Methods: We evaluated all patients who underwent radical prostatectomy between 1990 and 1999. Patients with pathological lymph node negative disease who received androgen deprivation therapy were then separated into 5 groups for analysis based on the time of hormone therapy initiation: 1-adjuvant androgen deprivation, 2-androgen deprivation therapy started at a postoperative prostate specific antigen of 0.4 ng/ml or greater, 3-at prostate specific antigen 1.0 or greater, 4-at prostate specific antigen 2.0 or greater and 5-at systemic progression. The first 4 groups were matched by clinical and pathological features to control groups who did not receive androgen deprivation after surgery using a nested, matched cohort design. Median followup for the entire cohort was 10 years. Clinical end points included systemic progression-free survival and cancer specific survival. Results: After matching clinicopathological variables adjuvant androgen deprivation therapy was associated with improved 10-year systemic progression-free survival (95% vs 90%, p <0.001) and 10-year cancer specific survival (98% vs 95%, p = 0.009), although overall survival for these patients remained unchanged (84% vs 83%, p = 0.427). In contrast, we found that men who started hormonal therapy at a postoperative prostate specific antigen of 0.4 or greater, 1.0 or 2.0 did not have improved systemic progression-free or cancer specific survival. Conclusions: Adjuvant hormonal therapy modestly improves cancer specific survival and systemic progression-free survival after prostatectomy. The benefit of hormone therapy is lost when androgen deprivation is delivered at the time of prostate specific antigen recurrence or systemic progression.
KW - hormones
KW - prostatectomy
KW - prostatic neoplasms
KW - survival
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U2 - 10.1016/j.juro.2008.01.022
DO - 10.1016/j.juro.2008.01.022
M3 - Article
C2 - 18353378
AN - SCOPUS:41749083018
VL - 179
SP - 1830
EP - 1837
JO - Investigative Urology
JF - Investigative Urology
SN - 0022-5347
IS - 5
ER -