International Journal of Clinical Oncology

, Volume 20, Issue 5, pp 1018–1025 | Cite as

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

  • Takuya KoieEmail author
  • Koji Mitsuzuka
  • Takahiro Yoneyama
  • Shintaro Narita
  • Sadafumi Kawamura
  • Yasuhiro Kaiho
  • Norihiko Tsuchiya
  • Tatsuo Tochigi
  • Tomonori Habuchi
  • Yoichi Arai
  • Chikara Ohyama
  • Tohru Yoneyama
  • Yuki Tobisawa
Original Article



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.


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.


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).


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.


High-risk prostate cancer Prostatectomy Neoadjuvant therapy LHRH plus estramustine Propensity score analysis 


Conflict of interest

No author has any conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2015

Authors and Affiliations

  • Takuya Koie
    • 1
    Email author
  • Koji Mitsuzuka
    • 2
  • Takahiro Yoneyama
    • 1
  • Shintaro Narita
    • 3
  • Sadafumi Kawamura
    • 4
  • Yasuhiro Kaiho
    • 2
  • Norihiko Tsuchiya
    • 3
  • Tatsuo Tochigi
    • 4
  • Tomonori Habuchi
    • 3
  • Yoichi Arai
    • 2
  • Chikara Ohyama
    • 1
  • Tohru Yoneyama
    • 1
  • Yuki Tobisawa
    • 1
  1. 1.Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
  2. 2.Department of UrologyTohoku University Graduate School of MedicineSendaiJapan
  3. 3.Department of UrologyAkita University Graduate School of MedicineAkitaJapan
  4. 4.Department of UrologyMiyagi Cancer CenterNatoriJapan

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