Immediate adjuvant ADT post surgery: effective but …
Posted Sep 28 2008 7:03pm
The theoretical value of early adjuvant hormone therapy in prolonging survival is known. The practical value to the individual patient, when compared to the side effects and potential adverse consequences (including the cardiovascular adverse event mentioned in the immediately preceding blog post), remains open to considerable question, however.
A report in the Journal of Urology addresses data on all patients who underwent a radical prostatectomy at the Mayo Clinic between 1990 and 1999. Patients who had lymph node negative disease were categorized into five different groups as follows, based on the time of hormone therapy initiation:
Patients who received immediate adjuvant androgen deprivation
Patients who received androgen deprivation therapy started at a postoperative PSA level of ≥ 0.4 ng/mL
Patients who received androgen deprivation therapy started at a protsoperative PSA level of ≥ 1.0 ng/mL
Patients who received androgen deprivation therapy started at a protsoperative PSA level of ≥ 2.0 ng/mL
Patients who had systemic progression of their disease
The first four groups were matched by clinical and pathological features to control groups who did not receive androgen deprivation after surgery. Median follow-up for the patients was 10 years. Clinical end points included systemic progression-free survival and cancer-specific survival.
The authors state that immediate ”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).” By contrast, they note that men who started ADT at postoperative PSA levels of ≥ 0.4, ≥ 1.0 or ≥ 2.0 ng/mL showed no improvement in systemic progression-free or cancer-specific survival.
They go on to conclude that, “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.”
The “New” Prostate Cancer InfoLink draws a rather different conclusion from the available data, as follows: Although there appears to be a very modest survival benefit associated with immediate adjuvant androgen deprivation in the patient cohort described, (a) this is a retrospective analysis (which leaves many questions unanswered) and (b) this very modest benefit (compared to patients who received no ADT post surgery) does not address any of the quality of life or side effect issues related to the immediate use of hormone therapy. We still need to know whether the putative survival benefit is worth the presumed losses in quality of life.