The Effect of Neoadjuvant Hormonal Treatment in Prostate Cancer on Biochemical Recurrence

Kanghyon Song; Hongzoo Park; Ji-Yeon Han; Chang Hee You; Hanjong Ahn; Choung-Soo Kim

doi:10.4111/kju.2007.48.11.1125

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Song, Park, Han, You, Ahn, and Kim: The Effect of Neoadjuvant Hormonal Treatment in Prostate Cancer on Biochemical Recurrence

Original Article

Korean Journal of Urology

Korean Journal of Urology 2007; 48(11): 1125-1130.

Published online: 30 November 2007

DOI: https://doi.org/10.4111/kju.2007.48.11.1125

The Effect of Neoadjuvant Hormonal Treatment in Prostate Cancer on Biochemical Recurrence

Kanghyon Song, Hongzoo Park, Ji-Yeon Han, Chang Hee You, Hanjong Ahn, Choung-Soo Kim

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author (cskim@amc.seoul.kr)

Received 20 July 2007 Accepted 30 August 2007

Abstract

Purpose

When combined with surgery, neoadjuvant hormonal therapy (NHT) has not demonstrated a significant benefit for meaningful clinical endpoints such as progression-free survival or overall survival. We evaluated the effect of NHT on prostate cancer.

Materials and Methods

From 1995 to 2004, 519 patients underwent radical retropubic prostatectomy (RRP). One-hundred thirty of them were included in this retrospective case-control study and they were assessed for age, the preoperative prostate-specific antigen (PSA) level, the clinical stage and the biopsy Gleason score (GS). The subjects were divided into two groups: the RRP only group (n=65) and the NHT group (n=65), and these were matched for the 3 above mentioned parameters. The protocols for NHT were maximal androgen blockade (n=40), antiandrogen only (n=8), and LHRH analogue only (n=17). Biochemical recurrence was defined as a level of serum PSA of 0.2ng/ml or greater on 2 consecutive evaluations.

Results

The mean age of the RRP only group and the NHT group was 64.2 and 63.5, respectively (p>0.05). The rates of a positive surgical margin and biochemical recurrence in the NHT group were 49.2% and 42.5%, respectively, and they were 46.2% and 46.2%, respectively, in RRP only group, and there was no statistical difference between the two groups. In high risk patients (clinical stage≥T3, biopsy GS≥8, serum PSA>20ng/ml), NHT group was not differences compared with the RRP group. Neither the duration (3 months vs. 6 months) of NHT nor the regimens of NHT improved the clinical and surgical outcome.

Conclusions

NHT did not improve biochemical recurrence and the positive surgical margin.

Keywords: Prostate cancer, Neoadjuvant therapy, Recurrence

Figures and Tables

Fig. 1

Prostate-specific antigen (PSA) recurrence free rate according to neoadjuvant hormonal treatment (NHT), the duration of NHT and the methods of NHT. RP: radical prostatectomy, MAB: maximal androgen blockade, LHRH: luteinizing hormone-releasing hormone.

Fig. 2

Prostate-specific antigen (PSA) recurrence free rate by neoadjuvant hormonal treatment (NHT) in the high risk patients. RP: radical prostatectomy.

Table 1

Preoperative clinicopathological characteristics

RP: radical prostatectomy, PSA: prostate-specific antigen, P-Bx: prostate biopsy, ^*: statistical analysis by Student's t-test, ^†: statistical analysis by chi-square test

Table 2

Postoperative clinicopathological characteristics

RP: radical prostatectomy, ^*: statistical analysis by Wilcoxon signed rank test, ^†: statistical analysis by chi-square test

Table 3

Postoperative clinicopathological characteristics according to the duration of NHT

NHT: neoadjuvant hormonal treatment, RP: radical prostatectomy, ^*: statistical analysis by ANOVA, ^†: statistical analysis by chi-square test

Table 4

Postoperative clinicopathological characteristics according to NHT

NHT: neoadjuvant hormonal treatment, RP: radical prostatectomy, MAB: maximal androgen blockade, LHRH: luteinizing hormone-releasing hormone, ^*: statistical analysis by ANOVA, ^†: statistical analysis by chi-square test

Table 5

Postoperative clinicopathological characteristics in the high risk patients

RP: radical prostatectomy, ^*: statistical analysis by statistical analysis by Wilcoxon signed rank test, ^†: statistical analysis by chi-square test

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