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.

Abstract

BACKGROUND:

The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with a neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). In the present study, we used a retrospective design via propensity score matching to elucidate the clinical benefit of neoadjuvant LHRH+EMP for high-risk Pca.

METHODS:

The Michinoku Urological Cancer Study Group database contained data for 1,268 consecutive Pca patients treated with RP alone at 4 institutions between April 2000 and March 2011 (RP alone group). In the RP alone group, we identified 386 high-risk Pca patients. The neoadjuvant LHRH+EMP group included 274 patients with high-risk Pca treated between September 2005 and November 2013 at Hirosaki University. Neoadjuvant LHRH+EMP therapy included LHRH and EMP administration at a dose of 280 mg/day for 6 months before RP. The outcome measures were overall survival (OS) and BRFS.

RESULTS:

The propensity score-matched analysis indicated 210 matched pairs from both groups. The 5-year BRFS rates were 90.4 and 65.8 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P < 0.0001). The 5-year OS rates were 100 and 96.1 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P = 0.110).

CONCLUSIONS:

Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP appeared to reduce the risk of biochemical recurrence. A prospective randomized study is warranted to determine the clinical implications of the neoadjuvant therapy described here.

• Authors: Takuya Koie, Koji Mitsuzuka, Takahiro Yoneyama, Shintaro Narita, Sadafumi Kawamura, Yasuhiro Kaiho, Norihiko Tsuchiya, Tatsuo Tochigi, Tomonori Habuchi, Yoichi Arai, Chikara Ohyama, Tohru Yoneyama, Yuki Tobisawa
• Journal: International journal of clinical oncology (Int J Clin Oncol) Vol. 20 Issue 5 Pg. 1018-25 (Oct 2015) ISSN: 1437-7772 [Electronic] Japan
• PMID: 25681879 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Hormonal
• Goserelin
• Gonadotropin-Releasing Hormone
• Estramustine
• Prostate-Specific Antigen
• Leuprolide

Topics

• Aged
• Antineoplastic Agents, Hormonal (administration & dosage)
• Estramustine (administration & dosage)
• Gonadotropin-Releasing Hormone (agonists)
• Goserelin (administration & dosage)
• Humans
• Leuprolide (administration & dosage)
• Male
• Middle Aged
• Neoadjuvant Therapy
• Propensity Score
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (blood, drug therapy, surgery)
• Retrospective Studies
• Survival Analysis