Abstract
Background
The outcomes of three-dimensional conformal radiation therapy (3D-CRT) combined with neoadjuvant hormonal therapy (NAHT) in Japanese patients with locally advanced prostate cancer who initiated salvage hormonal therapy (SHT) at a relatively early phase were evaluated.
Methods
Between April 1998 and April 2003, 70 Japanese patients with T3N0M0 prostate cancer who received radical 3D-CRT treatment were evaluated. The median age, initial prostate-specific antigen (PSA) level, and duration of NAHT were 73 years old, 26.3 ng/ml, and 4 months, respectively. Seventy grays were given in 35 fractions that were confined to the prostate and seminal vesicles. Adjuvant hormonal therapy was not administered after 3D-CRT in any of the cases.
Results
The median follow-up period was 64.9 months. The median PSA value at the time of initiation of SHT was 5.0 ng/ml (range 0.1–21.6 ng/ml). Overall, disease-specific, PSA failure-free (based on the Phoenix definition) and SHT-free survival rates at 5 years were 90.3% (95% CI 86.5–94.0), 96.5% (94.0–98.9), 60.5% (48.2–72.7), and 63.5% (57.2–69.8), respectively. Therefore, two-thirds of the patients were still hormone-free at 5 years.
Conclusions
PSA control rates in our series of Japanese patients with stage T3N0M0 prostate cancer treated with the standard dose of 3D-CRT combined with NAHT seemed higher than expected. This approach involving 3D-CRT combined with NAHT with the initiation of SHT at PSA values of around 5 ng/ml may be one option for Japanese patients with locally advanced prostate cancer, although further prospective study is required to confirm the validity.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66
Weir HK, Thun MJ, Hankey BF et al (2003) Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 95:1276–1299
Japanese Ministry of Health, Labour and Welfare (2005) The number and rate of death. http://www.dbtk.mhlw.go.jp/toukei/youran/data18k/1-27.xls
Japanese Ministry of Health, Labour and Welfare (2005) The number and rate of death by malignancy. http://www.dbtk.mhlw.go.jp/toukei/youran/data18k/1-31.xls
Ohshima A, Kuroishi T, Tashima K et al (2004) Cancer morbidity/mortality/prognosis, 2004. Shinohara, Tokyo
Japanese Urological Association (2005) Clinicopathological statistics on registered prostate cancer patients in Japan: 2000 report from the Japanese Urological Association. Int J Urol 12:46–61
Zhang Y, Glass A, Bennett N et al (2004) Long-term outcomes after radical prostatectomy performed in a community-based health maintenance organization. Cancer 100:300–307
Pilepich MV, Winter K, John MJ et al (2001) Phase III Radiation Therapy Oncology Group (RTOG) Trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 50:1243–1252
Kumar S, Shelley M, Harrison C et al (2006) Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database Syst Rev CD006019
Bolla M, Gonzalez D, Warde P et al (1997) Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337:295–300
Bolla M, Collette L, Blank L et al (2002) Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 360:103–106
Bolla M, de Reijke TM, Van Tienhoven G et al (2009) Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 360:2516–2527
Fukagai T, Namiki TS, Carlile RG et al (2006) Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men. BJU Int 97:1190–1193
Mitsumori M, Sasaki Y, Mizowaki T et al (2006) Results of radiation therapy combined with neoadjuvant hormonal therapy for stage III prostate cancer: comparison of two different definitions of PSA failure. Int J Clin Oncol 11:396–402
Zhu S, Mizowaki T, Nagata Y et al (2005) Comparison of three radiotherapy treatment planning protocols of definitive external-beam radiation for localized prostate cancer. Int J Clin Oncol 10:398–404
Kaplan EL Meier P (1958) Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481
Zietman AL, Christodouleas JP, Shipley WU (2005) PSA bounces after neoadjuvant androgen deprivation and external beam radiation: impact on definitions of failure. Int J Radiat Oncol Biol Phys 62:714–718
Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974
Pilepich MV, Winter K, Lawton CA et al (2005) Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma—long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 61:1285–1290
Pilepich MV, Caplan R, Byhardt RW et al (1997) Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group Protocol 85-31. J Clin Oncol 15:1013–1021
Hanks GE, Pajak TF, Porter A et al (2003) Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol 21:3972–3978
Crook J, Ludgate C, Malone S et al (2004) Report of a multicenter Canadian phase III randomized trial of 3 months vs. 8 months neoadjuvant androgen deprivation before standard-dose radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 60:15–23
Roach M 3rd, Lu J, Pilepich MV et al (2000) Predicting long-term survival, and the need for hormonal therapy: a meta-analysis of RTOG prostate cancer trials. Int J Radiat Oncol Biol Phys 47:617–627
Saito T, Kitamura Y, Komatsubara S et al (2006) Outcomes of locally advanced prostate cancer: a single institution study of 209 patients in Japan. Asian J Androl 8:555–561
Akakura K, Isaka S, Akimoto S et al (1999) Long-term results of a randomized trial for the treatment of stages B2 and C prostate cancer: radical prostatectomy versus external beam radiation therapy with a common endocrine therapy in both modalities. Urology 54:313–318
National Comprehensive Cancer Network (2010) NCCN clinical practice guidelines in oncology prostate cancer V.I.2010. http://www.nccn.org/
National Cancer Institute (2010) Prostate cancer treatment (PDQ®). http://www.cancer.gov/
Japanese Ministry of Health, Labour and Welfare (2005) The 20th life tables. http://www.mhlw.go.jp/english/database/db-hw/lifetb20th/table-m.html
Denham JW, Steigler A, Lamb DS et al (2005) Short-term androgen deprivation and radiotherapy for locally advanced prostate cancer: results from the Trans-Tasman Radiation Oncology Group 96.01 randomised controlled trial. Lancet Oncol 6:841–850
Laverdiere J, Nabid A, De Bedoya LD et al (2004) The efficacy and sequencing of a short course of androgen suppression on freedom from biochemical failure when administered with radiation therapy for T2-T3 prostate cancer. J Urol 171:1137–1140
Pilepich MV, Krall JM, al-Sarraf M et al (1995) Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 45:616–623
Roach M 3rd, DeSilvio M, Lawton C et al (2003) Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 21:1904–1911
Shipley WU, Desilvio M, Pilepich MV et al (2006) Early initiation of salvage hormone therapy influences survival in patients who failed initial radiation for locally advanced prostate cancer: a secondary analysis of RTOG Protocol 86-10. Int J Radiat Oncol Biol Phys 64:1162–1167
Yamanaka H, Ito K, Naito S et al (2005) Effectiveness of adjuvant intermittent endocrine therapy following neoadjuvant endocrine therapy and external beam radiation therapy in men with locally advanced prostate cancer. Prostate 63:56–64
Acknowledgments
This work was partially supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (20229009).
Conflict of interest statement
Authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Sakamoto, M., Mizowaki, T., Mitsumori, M. et al. Long-term outcomes of three-dimensional conformal radiation therapy combined with neoadjuvant hormonal therapy in Japanese patients with locally advanced prostate cancer. Int J Clin Oncol 15, 571–577 (2010). https://doi.org/10.1007/s10147-010-0109-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-010-0109-y