The optimal treatment for high-risk prostate cancer (PCa) remains to be established. We previously reported favorable, biochemical recurrence-free survival in high-risk PCa patients treated with a neoadjuvant gonadotropin-releasing hormone agonist or antagonist and estramustine phosphate (EMP) (chemohormonal therapy; CHT) followed by radical prostatectomy (RP). We conducted a retrospective study to elucidate the clinical benefit of neoadjuvant CHT for high-risk PCa patients.
We reviewed the clinical and pathological records of 1254 PCa patients who underwent RP and bilateral pelvic lymphadenectomy between July 1996 and April 2016 at Hirosaki University. According to the D’Amico risk classification, we focused on 613 patients in the high-risk group. The high-risk PCa patients were further divided into two groups based on whether the patients received neoadjuvant CHT before RP (EMP group) or not (non-EMP group). The endpoint was overall survival (OS) after surgery.
The 5- and 10-year OS rates were 98.5 and 92.6%, respectively. The 10-year OS rate in the EMP group was significantly higher compared to the non-EMP group (P = 0.021). In multivariate analysis, administration of neoadjuvant CHT, lymph node involvement, and castration-resistant PCa status were significantly associated with OS.
RP with neoadjuvant CHT using EMP for high-risk PCa patients provided excellent long-term OS.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Lester-Coll NH, Goldhaber SZ, Sher DJ et al (2013) Death from high-risk prostate cancer versus cardiovascular mortality with hormone therapy. Cancer 119:1808–1815
Yuh B, Artibani W, Heidenreich A et al (2013) The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review. Eur Urol 65:918–927
Yossepowitch O, Eggener SE, Serio AM et al (2008) Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol 53:950–959
Loeb S, Schaeffer EM, Trock BJ et al (2010) What are the outcomes of radical prostatectomy for high-risk prostate cancer? Urology 76:710–714
Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137
Sooriakumaran P, Nyberg T, Akre O et al (2014) Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 348:g1502
Culp SH, Schellhammer PF, Williams MB (2014) Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. Eur Urol 65:1058–1066
Koie T, Ohyama C, Yamamoto H et al (2012) Safety and effectiveness of neoadjuvant luteinizing hormone-releasing hormone agonist plus low-dose estramustine phosphate in high-risk prostate cancer: a prospective single-arm study. Prostate Cancer Prostatic Dis 15:397–401
Koie T, Mitsuzuka Koji, Yoneyama Takahiro et al (2015) 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
Hagiwara K, Koie T, Ohyama C et al (2017) Efficacy of a neoadjuvant gonadotropin-releasing hormone antagonist plus low-dose estramustine phosphate in high-risk prostate cancer: a single-center study. Int Urol Nephrol. doi:10.1007/s11255-017-1546-6 (in press)
Koie T, Yamamoto H, Hatakeyama S et al (2011) Minimum incision endoscopic radical prostatectomy: clinical and oncological outcomes at a single institute. Eur J Surg Oncol 37:805–810
Narita T, Koie T, Ookubo T et al (2017) The impact of extended lymph node dissection versus neoadjuvant therapy with limited lymph node dissection on biochemical recurrence in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis. Med Oncol 34:1
Epstein JI, Allsbrook WC Jr, Amin MB et al (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242
American Joint Committee on Cancer (AJC) (2010) Urinary bladder. In: Edge SB, Byrd DR, Compton CC et al (eds) AJCC cancer staging manual, 7th edn. Springer, New York, pp 457–468
Perkins NJ, Schisterman EF (2006) The inconsistency of ‘optimal’ cutpoints obtained using two criteria based on the receiver operating characteristics curve. Am J Epidemiol 163:670–675
Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479
James ND, Sydes MR, Clarke NW et al (2016) Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 387:1163–1177
Narita S, Koie T, Yamada S et al (2016) A prospective multicenter study of intermittent chemotherapy with docetaxel and prednisolone for castration-resistant prostate cancer. Jpn J Clin Oncol. doi:10.1093/jjco/hyw021 (in press)
Walsh PC, Donker PJ (1981) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128:492–497
Meng MV, Elkin EP, Latini DM et al (2005) Treatment of patients with high risk localized prostate cancer: results from cancer of the prostate strategic urological research endeavor (CaPSURE). J Urol 173:1557–1561
Merio T, San Francisco IF, Rojas PA et al (2013) Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up. BMC Cancer 13:530–538
Ward JF, Slezak JM, Blute ML et al (2005) Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 95:751–756
Wilt TJ, Brawer MK, Jones KM et al (2012) Radical prostatectomy versus observation for localized prostate cancer. N Eng J Med 367:203–213
Abdollah F, Sun M, Schmitges J et al (2012) Survival benefit of radical prostatectomy in patients with localized prostate cancer: estimations of the number needed to treat according to tumor and patient characteristics. J Urol 188:73–83
Gandaglia G, Sun M, Trinh QD (2014) Survival benefit of definitive therapy in patients with clinically advanced prostate cancer: estimations of the number needed to treat based on competing-risks analysis. BJU Int 114:E62–E69
Cha EK, Eastham JA (2015) Chemotherapy and novel therapeutics before radical prostatectomy for high-risk clinically localized prostate cancer. Urol Oncol 33:217–225
Lou DY, Fong L (2014) Neoadjuvant therapy for localized prostate cancer: examining mechanism of action and efficacy within tumor. Urol Oncol 34:182–192
This study was supported by the Grants-in-aid for Scientific Research from the Japan Society for the Promotion of Science (15H02563) (to CO), (15K15579) (to CO) and (17K11118) (to TK).
Conflict of interest
No author has any conflict of interest.
About this article
Cite this article
Fujita, N., Koie, T., Ohyama, C. et al. Overall survival of high-risk prostate cancer patients who received neoadjuvant chemohormonal therapy followed by radical prostatectomy at a single institution. Int J Clin Oncol 22, 1087–1093 (2017). https://doi.org/10.1007/s10147-017-1160-8
- Prostate cancer
- Radical prostatectomy
- Neoadjuvant chemohormonal therapy
- Estramustine phosphate
- Overall survival