New data published by clinical researchers at the Mayo Clinic have suggested that there is no overall survival benefit associated with adjuvant hormone therapy after surgery in men with pathological T3b disease.
In the February issue of BJU International, Siddiqui et al. have reported data from a retrospective analysis of data from the 12,000+ patients treated surgically for prostate cancer at the Mayo Clinic between 1987 and 2002. Among this database, they were able to identify 191 men who were known to have seminal invasion at the time of surgery (pT3b disease), had negative lymph nodes, and who received immediate, adjuvant deprivation therapy (ADT).
They compared the follow-up data from these 191 men with data from a carefully matched set of patients with pT3b prostate cancer who did not receive adjuvant ADT. Clinical endpoints included biochemical progression-free survival (BPFS), local recurrence-free survival (LRFS), systemic progression-free survival (SPFS), cancer-specific survival (CSS), and overall survival.
The results of their analysis showed the following:
- Median postoperative follow-up was 10 years.
- Compared to the patients who receive no adjuvant ADT, patients who did receive adjuvant ADT had
- The type of ADT given to these patients (either LHRH agonist monotherapy or bilateral orchiectomy) appeared to make no difference to survival outcomes.
It is hardly surprising that immediate adjuvant hormone therapy would have a statistically significant impact on local and systemic survival after radical prostatectomy for men with pT3b prostate cancer. If you suppress hormonal expression in such men, you will inevitable affect biochemical recurrence of their disease. It is also not surprising that there is a small impact on prostate cancer-specific survival in a study of this type but the clinical significance of the finding has to be questioned because of the retrospective, case-matched nature of the study.
And most importantly, the study clearly shows no impact of immediate adjuvant hormonal therapy on the overall survival of an otherwise wide range of men with pT3 disease.
Now it may well be the case that there is an identifiable subgroup of men with pT3 disease who would demonstrate an overall survival benefit from adjuvant ADT post-surgery. However, these might well be the same set of men who would benefit from adjuvant radiation therapy post-surgery those with high risk disease prior to their surgery. It would take a large, complex clinical trial to evaluate this possibility, and given the other unanswered questions in the management of prostate cancer, this may not be a high priority question.
It should also be noted that hormone therapy can be given early to men with progressive disease after surgery and adjuvant radiation therapy. Giving immediate, adjuvant hormone therapy to most such men today is potentially exposing them to a higher risk for complications and side effects than giving them immediate, adjuvant radiation therapy.
New data published by clinical researchers at the Mayo Clinic have suggested that there is no overall survival benefit associated with adjuvant hormone therapy after surgery in men with pathological T3b disease.
In the February issue of BJU International, Siddiqui et al. have reported data from a retrospective analysis of data from the 12,000+ patients treated surgically for prostate cancer at the Mayo Clinic between 1987 and 2002. Among this database, they were able to identify 191 men who were known to have seminal invasion at the time of surgery (pT3b disease), had negative lymph nodes, and who received immediate, adjuvant deprivation therapy (ADT).
They compared the follow-up data from these 191 men with data from a carefully matched set of patients with pT3b prostate cancer who did not receive adjuvant ADT. Clinical endpoints included biochemical progression-free survival (BPFS), local recurrence-free survival (LRFS), systemic progression-free survival (SPFS), cancer-specific survival (CSS), and overall survival.
The results of their analysis showed the following:
It is hardly surprising that immediate adjuvant hormone therapy would have a statistically significant impact on local and systemic survival after radical prostatectomy for men with pT3b prostate cancer. If you suppress hormonal expression in such men, you will inevitable affect biochemical recurrence of their disease. It is also not surprising that there is a small impact on prostate cancer-specific survival in a study of this type but the clinical significance of the finding has to be questioned because of the retrospective, case-matched nature of the study.
And most importantly, the study clearly shows no impact of immediate adjuvant hormonal therapy on the overall survival of an otherwise wide range of men with pT3 disease.
Now it may well be the case that there is an identifiable subgroup of men with pT3 disease who would demonstrate an overall survival benefit from adjuvant ADT post-surgery. However, these might well be the same set of men who would benefit from adjuvant radiation therapy post-surgery those with high risk disease prior to their surgery. It would take a large, complex clinical trial to evaluate this possibility, and given the other unanswered questions in the management of prostate cancer, this may not be a high priority question.
It should also be noted that hormone therapy can be given early to men with progressive disease after surgery and adjuvant radiation therapy. Giving immediate, adjuvant hormone therapy to most such men today is potentially exposing them to a higher risk for complications and side effects than giving them immediate, adjuvant radiation therapy.