International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 1 , Pages 23-30 , January 2010

Is Biochemical Response More Important Than Duration of Neoadjuvant Hormone Therapy Before Radiotherapy for Clinically Localized Prostate Cancer? An Analysis of the 3- Versus 8-Month Randomized Trial

Presented at the 50th Annual American Society of Therapeutic Radiology Oncology Meeting, September 21–25, 2008, Boston, MA, and the 22nd Annual Canadian Association of Radiation Oncology Scientific Meeting, Montreal, PQ, Canada.

  • Abraham Alexander, M.D., F.R.C.P.C.

      Affiliations

    • Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada
    • Corresponding Author InformationReprint requests to: Abraham Alexander, M.D., BC Cancer Agency, Vancouver Island Centre, 2410 Lee Avenue, Victoria, BC, Canada, V8R 6V5. Tel: (250) 519-5575; Fax: (250) 519-2018
    • ,
  • Juanita Crook, M.D., F.R.C.P.C.

      Affiliations

    • Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
    • ,
  • Stuart Jones, B.Sc.

      Affiliations

    • Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada
    • ,
  • Shawn Malone, M.D., F.R.C.P.C.

      Affiliations

    • Department of Radiation Oncology, Ottawa Regional Cancer Center, Ottawa, ON, Canada
    • ,
  • Julie Bowen, M.D., F.R.C.P.C.

      Affiliations

    • Department of Radiation Oncology, Northeastern Ontario Regional Cancer Center, Sudbury, ON, Canada
    • ,
  • Pauline Truong, M.D., F.R.C.P.C.

      Affiliations

    • Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada
    • ,
  • Howard Pai, M.D., F.R.C.P.C.

      Affiliations

    • Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada
    • ,
  • Charles Ludgate, M.D., F.R.C.P.C.

      Affiliations

    • Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada

Received 18 June 2008 ,Revised 15 January 2009 ,Accepted 27 January 2009.

References 

  1. Bolla M, Collette L, Blank L, et al. Long-term results with immediate androgen suppression and external beam radiotherapy in patients with locally advanced prostate cancer (an EORTC study): A phase II randomized trial. Lancet. 2002;340:103–106
  2. Hanks GE, Pajak TF, Porter A, et al. A 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 Onol. 2003;21:3972–3978
  3. Roach M, Bae K, Pilepich M, et al. Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer: Long-term results of RTOG 8610. J Clin Oncol. 2008;26:585–591
  4. Lawton CA, Winter K, Murry 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 radiotherapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2001;49:937–946
  5. 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;37:247–252
  6. Labrie F, Depont A, Cosun L, et al. Downstaging of localized prostate cancer by neoadjuvant therapy with flutamide and lupron: The first controlled and randomized trial. Clin Invest Med. 1993;499–508
  7. Soloway MS, Sherif R, Wajsman Z, et al. for the Lupron Depot Neoadjuvant Prostate Cancer Study Group A randomized prospective study comparing radical prostatectomy alone vs radical prostatectomy preceded by androgen blockade in clinical stage B2 prostate cancer. J Urol. 1995;424–428
  8. Klotz LH, Goldenberg SL, Jewett M, et al. for the Canadian Urologic Oncology Group CUOG randomized trial of neoadjuvant androgen ablation before radical prostatectomy: 36 Month post-treatment PSA results. Urology. 1999;53:752–763
  9. Crook J, Ludgate C, Malone S, et al. Final report of a multicenter Canadian Phase III randomized trial of 3 vs 8 months neoadjuvant androgen deprivation before conventional-dose radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2009;73:327–333
  10. Ludgate C, Bishop D, Pai H, et al. Neoadjuvant hormone therapy and external beam radiotherapy for localized high risk prostate cancer: The importance of PSA nadir before radiation. Int J Radiat Oncol Biol Phys. 2005;62:1309–1315
  11. D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. J Am Med Assoc. 1998;280:969–974
  12. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481
  13. Goldenberg SL, Klotz LH, Srigley J, et al. for the Canadian Urologic Oncology Group Randomized, prospective, controlled study comparing radical prostatectomy alone and neo-adjuvant androgen withdrawal in the treatment of localized prostate cancer. J Urol. 1996;156:573–577
  14. Joon DL, Hasegawa M, Sikes C, et al. Supraadditive apoptotic response on R3327-G rat prostate tumors to androgen ablation and radiation. Int J Radiat Oncol Biol Phys. 1997;38:1071–1077
  15. Zeitman AL, Prince EA, Nakfoor BM, et al. Androgen deprivation and radiotherapy: Sequencing studies using the Shinogi in vivo tumor system. Int J Radiat Oncol Biol Phys. 1997;38:1076–1070
  16. Heymann JJ, Benson MC, O'Toole KM, et al. Phase II study of neoadjuvant androgen deprivation followed by external-beam radiotherapy with 9 months of androgen deprivation for intermediate- to high-risk localized prostate cancer. J Clin Onol. 2007;25:77–84
  17. Gleave ME, Goldenberg SL, Jones EC, et al. Biochemical and pathologic effects of 8 months of neoadjuvant androgen withdrawal therapy before radical prostatectomy in patients with clinically confined prostate cancer. J Urol. 1996;155:213–219
  18. Holzbeierlein J, McLaughlin L, Threasher JB, et al. Complications of androgen deprivation therapy for prostate cancer. Curr Opin Urol. 2004;14:177–183
  19. Basaria S, Leib J, Tang A, et al. Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrin. 2002;56:779–786
  20. Boxer RS, Kenny AM, Dowsett R, et al. The effect of 6 months of androgen deprivation on muscle and fat mass in older men with localized prostate cancer. Aging Male. 2005;8:207–213
  21. Chen Z, Maricic M, Nguyen P, et al. Low bone density and high percentage of body fat among men who were treated with androgen deprivation therapy for prostate carcinoma. Cancer. 2002;95:2136–2144
  22. 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. J Am Med Assoc. 2004;292:821–827
  23. Cahlon O, Zelefsky Amols H, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: Toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys. 2008;71:330–337
  24. Peeters STH, Heemsbergen WD, Kper PCM, et al. Dose-response in radiotherapy for localized prostate cancer: Results of the Dutch multicenter randomized phase III trial comparing 68Gy of radiotherapy with 78Gy. J Clin Oncol. 2006;24:1990–1996
  25. Pollack A, Zagars GK, Smith LG, et al. Preliminary results of a randomized radiotherapy dose-escalation study comparing 70Gy with 78Gy for prostate cancer. J Clin Oncol. 2000;18:3904–3911

 Conflict of interest: none.

PII: S0360-3016(09)00126-6

doi: 10.1016/j.ijrobp.2009.01.030

International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 1 , Pages 23-30 , January 2010

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