Radiotherapy plus androgen deprivation therapy for prostate-specific antigen persistence in lymph node-positive prostate cancer.

Abstract

The treatment for lymph node involvement (LNI) after radical prostatectomy (RP) has not been established. This study aimed to reveal the outcomes of various management strategies among patients with LNI after RP. Retrospectively, 561 patients with LNI after pelvic lymph node dissection (PLND) with RP treated between 2006 and 2019 at 33 institutions participating in the Japanese Urological Oncology Group were investigated. Metastasis-free survival (MFS) was the primary outcome. Patients were stratified by prostate-specific antigen (PSA) persistence after RP. Cox regression models were used to analyze the relationships between clinicopathological characteristics and survival. Survival analyses were conducted using the Kaplan-Meier method and log-rank test with or without propensity score matching. Prognoses, including MFS and overall survival, were prominently inferior among patients with persistent PSA compared with those without persistent PSA. In multivariate analysis, androgen deprivation therapy (ADT) plus radiotherapy (RT) was associated with better MFS than ADT alone among patients with persistent PSA (hazard ratio = 0.37; 95% confidence interval = 0.15-0.93; p = 0.034). Similarly, MFS and overall survival were significantly better for ADT plus RT than for ADT alone among patients with persistent PSA after propensity score matching. This study indicated that PSA persistence in LNI prostate cancer increased the risk of poor prognoses, and intensive treatment featuring the addition of RT to ADT might improve survival.

• Authors: Masaki Shiota, Dai Takamatsu, Takahiro Kimura, Kojiro Tashiro, Yoshiyuki Matsui, Ryotaro Tomida, Ryoichi Saito, Masakazu Tsutsumi, Akira Yokomizo, Yoshiyuki Yamamoto, Kohei Edamura, Makito Miyake, Shuichi Morizane, Takayuki Yoshino, Akihiro Matsukawa, Shintaro Narita, Ryuji Matsumoto, Takashi Kasahara, Kohei Hashimoto, Hiroaki Matsumoto, Masashi Kato, Shusuke Akamatsu, Akira Joraku, Manabu Kato, Takahiro Yamaguchi, Toshihiro Saito, Tomoyuki Kaneko, Atsushi Takahashi, Takuma Kato, Shinichi Sakamoto, Hideki Enokida, Hidenori Kanno, Naoki Terada, Shigetaka Suekane, Naotaka Nishiyama, Masatoshi Eto, Hiroshi Kitamura, Japanese Urological Oncology Group
• Journal: Cancer science (Cancer Sci) Vol. 113 Issue 7 Pg. 2386-2396 (Jul 2022) ISSN: 1349-7006 [Electronic] England
• PMID: 35485635 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Chemical References

• Androgen Antagonists
• Androgens
• Prostate-Specific Antigen

Topics

• Androgen Antagonists (therapeutic use)
• Androgens
• Humans
• Lymph Nodes (pathology)
• Male
• Prostate-Specific Antigen
• Prostatectomy (methods)
• Prostatic Neoplasms (drug therapy, radiotherapy)
• Retrospective Studies