Maximum vs. Mono Androgen Blockade and the Risk of Recurrence in Men With Localized Prostate Cancer Undergoing Brachytherapy
Received 22 August 2008; received in revised form 14 October 2008; accepted 21 October 2008. published online 23 February 2009.
Purpose
We examined whether maximum androgen blockade (MAB) is associated with a decreased recurrence risk vs. single-agent androgen suppression (monotherapy) for men undergoing brachytherapy (BT) for localized prostate cancer.
Methods and Materials
Data from 223 men in the Cancer of the Prostate Strategic Urologic Research Endeavor database who received androgen deprivation therapy (ADT) concurrent with BT for intermediate- or high-risk prostatic adenocarcinoma were included; 159 (71%) received MAB, and 64 (29%) monotherapy (luteinizing hormone-releasing hormone agonist or anti-androgen alone). Cox regression analysis was performed to assess whether the choice of ADT was associated with disease recurrence adjusting for known prognostic factors.
Results
Men who received MAB had similar Gleason scores, T categories, and pretreatment prostate-specific antigen as those who received monotherapy. After a median follow-up of 49 months, the use of MAB was not associated with a decrease in the risk recurrence (p = 0.72), after adjusting for known prognostic factors. A higher PSA at diagnosis (p = 0.03) and younger age at diagnosis (p < 0.01) were associated with increased recurrence risk. The 3-year recurrence free survival was 76% for patients in both monotherapy and MAB groups.
Conclusions
There are varied practice patterns in physicians' choice of the extent of concurrent ADT when used with brachytherapy for men with intermediate- or high-risk prostate cancer. Given a lack of demonstrated superiority from either ADT choice, both appear to be reasonable options.
∗Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA
†Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
‡Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA
§Department of Statistics, University of Connecticut, Storrs, CT
Reprint requests to: Dr. Ronald C. Chen, Department of Radiation Oncology, Brigham & Women's Hospital, L-2, 75 Francis Street, Boston, MA 02445. Tel: (617) 278-0330; Fax: (617) 732-7347
Previously presented in abstract form at the Genitourinary Cancers Symposium on February 15, 2008.
ABSTRACT