Skip to main content
SpringerLink
Log in

Hormone Therapy Adjuvant to Radiotherapy in Non-Metastatic Prostate Cancer Settings

Impact on Biochemical Control

  • Original Research Article
  • Published:
American Journal of Cancer

Abstract

Background:Hormone therapy is commonly used with radiotherapy in the treatment of prostate cancer. Aim:To provide a single-institution analysis of the benefits of hormone therapy with radiotherapy in different non-metastatic prostate cancer scenarios. Methods:The records of 527 patients receiving radiotherapy for locally advanced, localized, and post-prostatectomy disease were reviewed. For the 422 patients with localized disease, biochemical failure-free survival curves were generated for patients receiving or not receiving hormone therapy (with biochemical failure defined as three successive rises after prostate-specific antigen nadir). The survival curves were compared using the log-rank test and a multivariate analysis of all major patient, disease, and treatment factors was performed. Additionally, failure rates were compared using the chi-square test to determine the benefit of hormone therapy across each of the locally advanced, localized, and post-prostatectomy settings. Results:An advantage for the use of hormone therapy compared with radiotherapy alone was observed in the population with localized disease (3-year biochemical failure-free survival 78% vs 75%; p = 0.029). Of the patient, disease, and treatment factors analyzed, only clinical T-stage (p = 0.002), radiation dose (p = 0.006), and hormone therapy (p = 0.016) reached statistical significance on multivariate analysis. Furthermore, lower failure rates occured (with at least a trend observed [p < 0.10]) in patients receiving hormone therapy in each clinical scenario, with the exception of the localized low-risk subgroup. Conclusion:In a single-institution analysis, the addition of hormone therapy to radiotherapy was advantageous in all settings of non-metastatic prostate cancer except that of the very earliest disease presentation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Table II
Table III

Similar content being viewed by others

References

  1. Jani AB, Hellman S. Early prostate cancer: clinical decision-making. Lancet 2003; 361: 1048–53

    Article  Google Scholar 

  2. Gronberg H. Prostate cancer epidemiology. Lancet 2003; 361: 859–64

    Article  PubMed  Google Scholar 

  3. Jani AB, Roeske JC, Rash C. Intensity-modulated radiation therapy for prostate cancer. Clin Prostate Cancer 2003; 2: 98–105

    Article  PubMed  Google Scholar 

  4. Jani AB. Organ motion and IMRT in prostate cancer therapy. Cancer J 2003; 9: 244–6

    Article  PubMed  Google Scholar 

  5. Zelefsky MJ, Fuks Z, Hunt M, et al. High dose radiation delivered by intensity modulated conformai radiotherapy improves the outcome of localized prostate cancer. J Urol 2001; 166: 876–81

    Article  PubMed  CAS  Google Scholar 

  6. Pollack A, Zagars GK, Starkschall G, et al. Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002;53: 1097–105

    Article  PubMed  Google Scholar 

  7. Huggins C. Endocrine-induced regression of cancers. Science 1967; 156: 1050–4

    Article  PubMed  CAS  Google Scholar 

  8. Prostate Cancer Trialists’ Collaborative Group. Maximum androgen blockade in advanced prostate cancer: an overview of 22 randomised trials with 3283 deaths in 5710 patients. Lancet 1995; 346: 265–9

    Article  Google Scholar 

  9. Prostate Cancer Trialists’ Collaborative Group. Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Lancet 2000; 355: 1491–8

    Article  Google Scholar 

  10. Pilepich MV, Winter K, John MJ, et al. 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 2001; 50: 1243–52

    Article  PubMed  CAS  Google Scholar 

  11. Laverdiere J, Gomez JL, Cusan L, et al. Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys 1997; 37: 247–52

    Article  PubMed  CAS  Google Scholar 

  12. Lawton CA, Winter K, Murray K, et al. Updated results of the phase III Radiation Therapy Oncology Group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001; 49: 937–46

    Article  PubMed  CAS  Google Scholar 

  13. Bolla M, Collette L, Blank L, et al. 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 2002; 360: 103–6

    Article  PubMed  CAS  Google Scholar 

  14. Hanks GE, Pajak TF, Porter A, et al. 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 2003; 21: 3972–8

    Article  PubMed  CAS  Google Scholar 

  15. Roach III M, DeSilvio M, Lawton C, et al. 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 2003;21: 1904–11

    Article  PubMed  Google Scholar 

  16. Jani AB, Kao J, Hellman S. Hormone therapy adjuvant to external beam radiothapy for locally advanced prostate carcinoma: a complication-adjusted number-needed-to-treat analysis. Cancer 2003; 98: 2351–61

    Article  PubMed  CAS  Google Scholar 

  17. D’Amico AV, Schultz D, Loffredo M, et al. Biochemical outcome following external beam radiation therapy with or without androgen suppression therapy for clinically localized prostate cancer. JAMA 2000; 284: 1280–3

    Article  PubMed  Google Scholar 

  18. Jani AB, Basu A, Abdalla I, et al. The impact of hormone therapy when combined with external beam radiotherapy for early-stage, intermediate- or high-risk prostate cancer. Am J Clin Oncol 2003; 26: 382–5

    PubMed  CAS  Google Scholar 

  19. Lee LN, Stock RG, Stone NN. Role of hormonal therapy in the management of intermediate- to high-risk prostate cancer treated with permanent radioactive seed implantation. Int J Radiat Oncol Biol Phys 2002; 52: 444–52

    Article  PubMed  CAS  Google Scholar 

  20. D’amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969–74

    Article  PubMed  Google Scholar 

  21. Merrick GS, Butler WM, Galbreath RW, et al. Does hormonal manipulation in conjunction with permanent interstitial brachytherapy, with or without supplemental external beam irradiation, improve the biochemical outcome for men with intermediate or high-risk prostate cancer? BJU Int 2003; 91: 23–9

    Article  PubMed  CAS  Google Scholar 

  22. Potters L, Torre T, Ashley R, et al. Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy. J Clin Oncol 2000; 18: 1187–92

    PubMed  CAS  Google Scholar 

  23. Martinez A, Galalae R, Gonzalez J, et al. No apparent benefit at 5 years from a course of neoadjuvant/ concurrent androgen deprivation for patients with prostate cancer treated with a high total radiation dose. J Urol 2003; 170: 2296–301

    Article  PubMed  Google Scholar 

  24. Jani AB, Kao J, Heimann R, et al. Hormone therapy adjuvant to external beam radiotherapy for early prostate cancer: a complication-adjusted number-needed to treat (NNT) analysis. Int J Radiat Oncol Biol Phys 2005; 61: 687–94

    Article  PubMed  CAS  Google Scholar 

  25. D’Amico AV, Manola J, Loffredo M, et al. 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004; 292: 821–7

    Article  PubMed  Google Scholar 

  26. Wiegel T, Bressel M, Carl UM. Adjuvant radiotherapy following radical prostatectomy: results of 56 patients. Eur J Cancer 1995; 31A: 5–11

    Article  PubMed  CAS  Google Scholar 

  27. Taylor N, Kelly JF, Kuban DA, et al. Adjuvant and salvage radiotherapy after radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 2003; 56: 755–63

    Article  PubMed  CAS  Google Scholar 

  28. de la Taille A, Flam TA, Thiounn N, et al. Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy. BJU Int 2002; 90: 887–92

    Article  Google Scholar 

  29. Katz MS, Zelefsky MJ, Venkatraman ES, et al. Predictors of biochemical outcome with salvage conformai radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol 2003; 21: 483–9

    Article  PubMed  Google Scholar 

  30. Eulau SM, Tate DJ, Stamey TA, et al. Effect of combined transient androgen deprivation and irradiation following radical prostatectomy for prostatic cancer. Int J Radiat Oncol Biol Phys 1998; 41: 735–40

    Article  PubMed  CAS  Google Scholar 

  31. King CR, Presti JrJC, Gill H, et al. Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? Int J Radiat Oncol Biol Phys 2004; 59: 341–7

    Article  PubMed  Google Scholar 

  32. Song DY, Thompson TL, Ramakrishnan V, et al. Salvage radiotherapy for rising or persistent PSA after radical prostatectomy. Urology 2002; 60: 281–7

    Article  PubMed  Google Scholar 

  33. Corn BW, Winter K, Pilepich MV. Does androgen suppression enhance the efficacy of postoperative irradiation? A secondary analysis of RTOG 85-31. Urology 1999; 54: 495–502

    Article  PubMed  CAS  Google Scholar 

  34. Jani AB, Sokoloff M, Shalhav A, et al. Androgen ablation adjuvant to post-prostatectomy radiotherapy: a complication-adjusted number-needed to treat analysis. Urology 2004; 64: 976–81

    Article  PubMed  Google Scholar 

  35. Jani AB, Blend MJ, Hamilton R, et al. Radioimmunoscintigraphy for postpros-tatectomy radiotherapy: analysis of toxicity and biochemical control. J Nucl Med 2004;45: 1315–22

    PubMed  CAS  Google Scholar 

  36. Jani AB, Blend MJ, Hamilton R, et al. Influence of radioimmunoscintigraphy on postprostatectomy radiotherapy treatment decision making. J Nucl Med 2004 45: 571–8

    PubMed  Google Scholar 

  37. Jani AB, Spelbring D, Hamilton R, et al. Impact of radioimmunoscintigraphy on definition of clinical target volume for radiotherapy after prostatectomy. J Nucl Med 2004; 45: 238–46

    PubMed  Google Scholar 

  38. American Society for Therapeutic Radiology and Oncology Consensus Panel consensus statement: guidelines for PSA following radiation therapy. Int j Radiat Oncol Biol Phys 1997; 37: 1035-41

    Google Scholar 

  39. Fleming TR, Lin DY. Survival analysis in clinical trials: past developments and future directions. Biometrics 2000; 56: 971–83

    Article  PubMed  CAS  Google Scholar 

  40. Dawson-Saunders B, Trapp RG. Basic and clinical biostatistics. East Norwalk (CT): Prentice Hall, 1990

    Google Scholar 

  41. Jani AB, Hand CM, Lujan AE, et al. Biological effective dose for comparison and combination of external beam and low-dose rate interstitial brachytherapy prostate cancer treatment plans. Med Dosim 2004; 29: 42–8

    Article  PubMed  Google Scholar 

  42. Singh R, Al-Hallaq H, Pelizzari CA, et al. Dosimetric quality endpoints for low-dose-rate prostate brachytherapy using biological effective dose (BED) vs conventional dose. Med Dosim 2003; 28: 255–9

    Article  PubMed  Google Scholar 

  43. Cancer and Leukemia Group B. Phase II study of neoadjuvant paclitaxel, estramustine, carboplatin, and androgen ablation followed by radiotherapy in patients with poor-prognosis locally advanced prostate cancer (CALGB 99811) [online]. Available from URL: http://www.calgb.org [Accessed 2006 Mar 29]

  44. Radiation Therapy Oncology Group. A phase III protocol of androgen suppression (AS) and radiation therapy (RT) vs AS and RT followed by chemotherapy with] paclitaxel, estramustine, and exisuland (TEE) for localized, high-risk, prostate cancer (RTOG P-0014) [online]. Available from URL: http://www.rtog.org [Accessed 2006 Mar 29]

  45. Radiation Therapy Oncology Group. A phase III randomized study of patients with] high-risk, hormone-naive prostate cancer: androgen blockade with 4 cycles of immediate chemotherapy versus androgen blockade with delayed chemotherapy (RTOG P-0014) [online]. Available from URL: https://www.rtog.org [Accessed 2006 Mar 29]

  46. Radiation Therapy Oncology Group. A phase III trial of the study of endocrine therapy used as a cytoreductive and cytostatic agent prior to radiation therapy in] good prognosis locally confined adenocarcinoma of the prostate (RTOG 94-08) [online]. Available from URL: http://www.rtog.org [Accessed 2006 Mar 29]

  47. Radiation Therapy Oncology Group. A phase III trial to evaluate the duration of neoadjuvant total androgen suppression (TAS) and radiation therapy (RT) in intermediate-risk prostate cancer (RTOG 99–10) [online]. Available from URL: http://www.rtog.org [Accessed 2006 Mar 29]

  48. Radiation Therapy Oncology Group. A phase III trial of radiation therapy with or without casodex in patients with PSA elevation following radical prostatectomy for pT3N0 carcinoma of the prostate (RTOG 96–01) [online]. Available frorm URL: http://www.rtog.org [Accessed 2006 Mar 29]

  49. Radiation Therapy Oncology Group. Phase III randomized study of adjuvant therapy for high-risk pT2-3N0 prostate cancer (RTOG P-0011) [online]. Available from URL: http://www.rtog.org [Accessed 2006 Mar 29]

  50. Michalski JM, Winter K, Purdy JA, et al. Toxicity after three-dimensional radiotherapy for prostate cancer on RTOG 9406 dose Level V. Int J Radiat Oncol Biol Phys 2005; 62: 706–13

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study

Author information

Authors and Affiliations

  1. Dept. of Radiation and Cellular Oncology, University of Chicago Hospitals, 5758 S. Maryland Ave., MC 9006, 60637, Chicago, IL, USA

    Ashesh B. Jani & John Gratzle

Authors
  1. Ashesh B. Jani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Gratzle
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jani, A.B., Gratzle, J. Hormone Therapy Adjuvant to Radiotherapy in Non-Metastatic Prostate Cancer Settings. Am J Cancer 5, 193–198 (2006). https://doi.org/10.2165/00024669-200605030-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00024669-200605030-00006

Keywords

Search

Navigation