Abstract
Purpose
Our study was to determine whether immediate androgen deprivation therapy (ADT) plus radiotherapy (RT) extends survival in men with node-positive prostate cancer (PCa) after radical prostatectomy (RP) compared with those who received ADT alone.
Methods
A total of 99 consecutive patients with pathological positive lymph nodes (pN1) PCa were included in this study to receive immediate ADT plus RT (n = 70) or to receive immediate ADT alone (n = 29). The primary endpoint was castration-resistant prostate cancer (CRPC) free survival; the secondary endpoints were distant metastasis-free survival. Cox regression was used to assess the independent risk factors for CRPC.
Results
The median follow-up time was 34.0 (24.8, 47.8) months and 34.25 (23.0, 49.0) months, respectively, in the ADT + RT group and ADT-alone group. The 5-year CRPC-free survival rate was 79.5% and 58.3%, respectively, in the ADT + RT group and ADT-alone group (p = 0.308). The 5-year distant metastasis-free survival rate was 71.4% and 38.8, respectively, in the ADT + RT group and ADT-alone group (p = 0.478). Compared with ADT-alone group, we saw a modest, but no significant improvement in CRPC-free survival and distant metastasis-free survival in ADT + RT group. The results of Cox regression showed that positive lymph nodes ≥ 4 was an independent risk factor for CRPC (p = 0.041).
Conclusions
We found that immediate ADT plus RT compared to ADT alone did not improve CRPC-free and metastasis-free survival. Multivariate Cox regression analyses also indicated that patients with positive lymph nodes < 4 may benefits from ADT plus RT.
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Data availability
All data generated or analyzed during the current study are included in this published article.
Abbreviations
- PCa:
-
Prostate cancer
- pN1:
-
Pathological positive lymph nodes
- RP:
-
Radical prostatectomy
- ADT:
-
Androgen deprivation therapy
- RT:
-
Radiotherapy
- CRPC:
-
Castration-resistant prostate cancer
- ePLND:
-
Extended pelvic lymph node dissection
- LAPC:
-
Locally advanced prostate cancer
- RT + ADT:
-
Adjuvant radiotherapy plus androgen deprivation therapy
- PSA:
-
Prostate specific antigen
- GS:
-
Gleason score
- BMI:
-
Body mass index
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Acknowledgements
I wish to thank Xu Gao, Yan Wang for advice on experimental design, Zhenyang Dong for data acquisition. The authors received no funding for this study.
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XG and YW contributed to the study conception and design. Material preparation, data collection and analysis were performed by HC, MQ, ZD and YW. The first draft of the manuscript was written by HC, MQ. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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All procedures performed in studies involving human participants were in accordance with the 1964 Declaration of Helsinki and its later amendments. As a retrospective study and data analysis were performed anonymously, this study was exempt from the ethical approval. Written informed consent was obtained from all participants.
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Chen, H., Qu, M., Shi, H. et al. Adjuvant radiotherapy in patients with node-positive prostate cancer after radical prostatectomy. J Cancer Res Clin Oncol 149, 4925–4932 (2023). https://doi.org/10.1007/s00432-022-04409-z
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DOI: https://doi.org/10.1007/s00432-022-04409-z