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Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: a propensity score-matched analysis

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Abstract

Background

The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with a neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). In the present study, we used a retrospective design via propensity score matching to elucidate the clinical benefit of neoadjuvant LHRH+EMP for high-risk Pca.

Methods

The Michinoku Urological Cancer Study Group database contained data for 1,268 consecutive Pca patients treated with RP alone at 4 institutions between April 2000 and March 2011 (RP alone group). In the RP alone group, we identified 386 high-risk Pca patients. The neoadjuvant LHRH+EMP group included 274 patients with high-risk Pca treated between September 2005 and November 2013 at Hirosaki University. Neoadjuvant LHRH+EMP therapy included LHRH and EMP administration at a dose of 280 mg/day for 6 months before RP. The outcome measures were overall survival (OS) and BRFS.

Results

The propensity score-matched analysis indicated 210 matched pairs from both groups. The 5-year BRFS rates were 90.4 and 65.8 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P < 0.0001). The 5-year OS rates were 100 and 96.1 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P = 0.110).

Conclusions

Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP appeared to reduce the risk of biochemical recurrence. A prospective randomized study is warranted to determine the clinical implications of the neoadjuvant therapy described here.

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Conflict of interest

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Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan

    Takuya Koie, Takahiro Yoneyama, Chikara Ohyama, Tohru Yoneyama & Yuki Tobisawa

  2. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Koji Mitsuzuka, Yasuhiro Kaiho & Yoichi Arai

  3. Department of Urology, Akita University Graduate School of Medicine, Akita, Japan

    Shintaro Narita, Norihiko Tsuchiya & Tomonori Habuchi

  4. Department of Urology, Miyagi Cancer Center, Natori, Japan

    Sadafumi Kawamura & Tatsuo Tochigi

Authors
  1. Takuya Koie
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  2. Koji Mitsuzuka
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  3. Takahiro Yoneyama
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  4. Shintaro Narita
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Correspondence to Takuya Koie.

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Koie, T., Mitsuzuka, K., Yoneyama, T. et al. Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: a propensity score-matched analysis. Int J Clin Oncol 20, 1018–1025 (2015). https://doi.org/10.1007/s10147-015-0802-y

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  • DOI: https://doi.org/10.1007/s10147-015-0802-y

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