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The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer

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Abstract

Analysis of the results of treatment of localised prostate cancer with radiation and surgery has identified patients who are at high risk of developing metastatic dissemination. High histologic grade, serum prostate specific antigen above 20 ng/ml, extension beyond the capsule of the prostate, and involvement of lymph nodes are highly predictive of metastatic risk. Antiandrogen therapy has high rates of activity in the treatment of overt metastatic disease prompting its assessment as an adjuvant treatment added to radiation therapy. There are now major prospective randomized trials which have been completed. The current evidence indicates that a large survival benefit ensues when antiandrogen therapy is added to radiation for appropriately selected patients. This adjuvant approach is likely to become the standard of care. Strategies for further enhancement of adjuvant therapy are discussed.

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References

  1. Mellinger, G., Gleason, D., Bailar, J. The histology and prognosis in carcinoma of the prostate. Front. Radiat. Ther. Oncol. 1967; 9: 267–273.

    Google Scholar 

  2. Zagars, G. Prostate-specific antigen as a prognostic factor for prostate cancer treated by external beam radiotherapy. Int. J. Radiat. Oncol. Biol. P Phys. 1992; 23: 47–53.

    CAS  Google Scholar 

  3. Critz, F., Levinson, A., Williams, W., Holladay, D. What PSA nadir level should be achieved after irradiation for prostate cancer? Proc. Am. Soc. Clin. Oncol. 1996; 15: 238.

    Google Scholar 

  4. Leibel, S., Fuks, Z., Zelefsky, M., Whitmore, W. The effects of local and regional treatment on the metastatic outcome in prostatic carcinoma with pelvic lymph node involvement. Int. J. Radiat. Oncol. Biol. Phys. 1993; 28: 7–16.

    Google Scholar 

  5. Zelefsky, M., Leibel, S., Kutcher, G., Kelson, S., Ling, C., Fuks, Z. The feasibility of dose escalation with three-dimensional conformai radiotherapy in patients with prostatic carcinoma. Cancer J. Sei. Am. 1995; 1: 142–150.

    CAS  Google Scholar 

  6. Armstrong, J. G. Three-dimensional conformai radiotherapy: Precision treatment of lung cancer. Chest Surgery Clinics of North America. 1994; 4: 29–43.

    PubMed  CAS  Google Scholar 

  7. Leibel, S., Kutcher, J., Mohan, R., Harrison, L., Armstrong, J., Zelefsky, M., LoSasso, T., Burman, C., Mageras, G., Chui, C., Brewster, L., Masterson, M. E., Lo, Y., Ling, C., Fuks, Z. Three-dimensional conformai radiation therapy at the Memorial Sloan-Kettering Cancer Center. Seminars in Radiation Oncology 1992; 2: 274–289.

    Article  PubMed  Google Scholar 

  8. Natkoor, B., Prince, E., Shipley, W., Zeitman, A. A randomized trial comparing local tumour control following irradiation alone versus combined androgen withdrawal and irradiation in an androgen sensitive prostate cancer xenograft. Int. J. Radiat. Oncol. Biol. Phys. 1995; 31 (Suppl): 189.

    Google Scholar 

  9. Zelefsky, M., Leibel, S., Burman, C., Kutcher, G., Harrison, A., Happerstet, L., Fuks, Z. Neoadjuvant hormonal therapy improves the therapeutic ratio in patients with bulky prostatic cancer treated with three-dimensional conformai radiation therapy. Int. J. Radiat. Oncol. Biol. P Phys. 1994; 29: 755–761.

    CAS  Google Scholar 

  10. Taplin, M., Bubley, G., Shuster, T., Frantz, M., Spooner, A., Ogata, G., Keer, H., Balk, S. Mutation of the androgen-receptor gene in metastatic androgen-independent prostate cancer. N. Engl. J. Med. 1995; 332: 1393–1398.

    Article  PubMed  CAS  Google Scholar 

  11. Isaka, S., Teshima, S., Akakura, K., Igarashi, T., Murakami, S., Shimazaki, J. Histologic effects of endocrine therapy for prostatic cancer in relation to clinical course. Jpn. J. Clin. Oncol. 1989; 19: 258–264.

    PubMed  CAS  Google Scholar 

  12. Kyprianou, N., English, H., Isaacs, J. Programmed cell death during regression of PC-82 human prostate cancer following androgen ablation. Cancer Res. 1990; 50: 3748–3753.

    PubMed  CAS  Google Scholar 

  13. Hobisch, A., Culig, Z., Radmayr, C., Bartsch, G., Klocker, H., Hittmair, A. Androgen receptor status of lymph node metastases from prostate cancer. The Prostate 1996; 28: 129–135.

    Article  PubMed  CAS  Google Scholar 

  14. Takeda, H., Akakura, K., Masai, M., Akimoto, S., Yatani, R., Shimazaki, J. Androgen receptor content of prostate carcinoma calls estimated by immunohistochemistry is related to prognosis of patients with stage D2 prostate carcinoma. Cancer 1996; 77: 934–940.

    Article  PubMed  CAS  Google Scholar 

  15. Balk, S., Bubley, G., Shuster, T. Mutated androgen receptors of prostate-cancer cells. N. Engl. J. Med. 1995; 333: 1010–1011.

    Article  Google Scholar 

  16. Pavone-Macalauso, M., de Voogt, H., Viggisno et al. Comparison of DES, cyproterone acetate, and medroxyprogesterone acetate in the treatment of advanced prostatic cancer. J. Urol. 1986; 136: 624–631.

    Google Scholar 

  17. Kaisary, A., Tyrrell, C., Peeling, W., Griffiths, K. Comparison of LHRH analogues (Zoladex) with orchiectomy in patients with metastatic prostatic carcinoma. Br. J. Urol. 1989; 67: 502–508.

    Article  Google Scholar 

  18. Tyrrell, C., Kaisary, A., Iversen, P., Anderson, J., Baert, L., Tammela, T., Chamberlain, M., Webster, A., Blackledge, G. A randomized comparison of casodex 150 mg versus castration in the treatment of advanced prostate cancer. Proc. Am. Soc. Clin. Oncol. 1996; 15: 192.

    Google Scholar 

  19. Denis, L., Murphy, G. Overview of phase III trials on combined androgen treatment in patients with metastatic prostate cancer. Cancer 1993, 72 (Supplement 1), 3888–3895.

    Article  PubMed  CAS  Google Scholar 

  20. Crawford, E., Eisenberger, M., McLeod, D., Spaulding, J., Benson, R., Dorr, A., Blumenstein, B., Davis, M., Goodman, P. A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N. Engl. J. Med. 1989; 321: 419–424.

    PubMed  CAS  Google Scholar 

  21. Denis, L., Whelan, P., Carneiro De Moura, J., Newling, D., Bono, A., Depauw, M., Sylvester, R. Goserelin acetate and flutamide versus bilateral orchiectomy: A phase III EORTC trial. Urology 1993; 42: 119–130.

    Article  PubMed  CAS  Google Scholar 

  22. Pilepich, M., Caplan, R., Al-Sarraf, M., John, M., Dogget, R., Sause, W., Lawton, C., Abrams, R., Rotman, M., Rubin, P., Shipley, W., Cox, J. Phase III trial of hormonal cytoreduction in conjunction with definitive radiotherapy in locally advanced prostate carcinoma: The emerging role of PSA in assessment of outcome. Int. J. Radiat. Oncol. Biol. Phys. 1993; 27 (Suppl 1): 246.

    Google Scholar 

  23. Neglia, W., Hussey, D., Johnson, D. Megavoltage radiation therapy for carcinoma of the prostate. Int. J. Radiat. Oncol. Biol. Phys. 1977; 2: 873–882.

    PubMed  CAS  Google Scholar 

  24. Zagars, G., Johnson, D., von Eschenbach, A., Hussey, D. Adjuvant estrogen following radiation therapy for stage C adenocarcinoma of the prostate: long-term results of a prospective randomized study. Int. J. Radiat. Oncol. Biol. Phys. 1988; 14: 1085–1091.

    PubMed  CAS  Google Scholar 

  25. The Veterans administration co-operative urological research group. Treatment and survival of patients with cancer of the prostate. Surgery, Gynaecology and Obstetrics 1967; 124: 1011–1017.

    Google Scholar 

  26. Bailar, J., Byar, D. Estrogen treatment for cancer of the prostate. Early results with 3 doses of diethylstilbestrol and placebo. Cancer 1970; 26: 257–261.

    Article  PubMed  Google Scholar 

  27. Bolla, M., Gonzalez, D., Warde, P., Dubois, J. B., Miranoff, R., Storme, G., Bernier, J., Kuten, A., Sternberg, C., Mattelaer, J., Lopez Torrecilla, J., Pfeffer, R., Collette, L., Gil, T., Bartelink, H.Immediate hormonal therapy improves locoregional control and survival in patients with locally advanced prostate cancer. Results of a randomized phase III clinical trial of the EORTC radiotherapy and genitourinary tract cancer cooperative groups. Proc. Am. Soc. Clin. Oncol. 1996; 15: 238.

    Google Scholar 

  28. Laverdiere, J., Gomez, J., Cusan, L., Suburu, E., Diamond, P., Lemay, M., Candas, B., Labrie, F. Beneficial effects of combination therapy administered prior and following external beam radiation therapy in localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 1995; 31 (Suppl): 189.

    Article  Google Scholar 

  29. Gleave, M., Goldenberg, L., Jones, E., Bruchovsky, N., Sullivan, L. Biochemical and pathological effects of 8 months of neoadjuvant androgne withdrawal therapy before radical prostatectomy in patients with clinically confined prostate cancer. The Journal of Urology 1996; 155: 213–219.

    Article  PubMed  CAS  Google Scholar 

  30. Schmidt, J., Gibbons, R., Murphy, G., Bartolucci, A. and the investigators of the national prostate cancer project. Evaluation of adjuvant estramustine phosphate, cyclophosphamide, and observation only following radical prostatectomy and definitive irradiation. The Prostate 1996; 28: 51–57.

    Article  PubMed  CAS  Google Scholar 

  31. Vogelzang, N. One hundred thirteen men with hormone-refractory prostate cancer died today. J. Clin. Oncol. 1996; 14: 1753–1755.

    PubMed  CAS  Google Scholar 

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  1. St. Luke’s Hospital, Dublin

    J. Armstrong

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  1. J. Armstrong
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Armstrong, J. The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer. Ir. J. Med. Sc. 167, 138–144 (1998). https://doi.org/10.1007/BF02937924

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