Radiotherapy + ADT following radical prostatectomy

A Canadian group has just added a little more to our knowledge about the role of neoadjuvant hormone therapy in association with radiotherapy after first-line radical prostatectomy (RP).

Pai et al. have reported data from a  retrospective analysis performed on 175 patients with clinically localized prostate cancer who were first treated with RP and who who subsequently received radiotherapy (dose range 50 Gy-68 Gy, which is still a slightly low dose range compared to the higher ranges observed normally today).

Twenty-two patients received adjuvant radiotherapy (ART), 57 received neoadjuvant androgen deprivation therapy (NADT) + ART, 15 received salvage radiation therapy (SRT), and 81 received NADT + SRT. Outcome was assessed by biochemical disease-free survival , prostate cancer-specific survival, and overall survival.

Biochemical disease-free survival at 5 years was observed in:

  • 67 percent of ART patients
  • 80 percent of NADT + ART patients
  • 27 percent of SRT patients
  • 62 percent of NADT + SRT patients

which would seem to suggest an overall benefit for patients who received NADT  + ART compared to other options. However, it turned out that on multivariate analysis the only three independent predictive factors of improved biochemical disease-free survival were a PSA level ≤ 0.2 ng/ml before radiotherapy, a low Gleason score, and positive surgical margins.  The patient’s age and his Gleason score were independent predictors of overall survival.

The authors conclude that:

  • The pre-radiotherapy PSA level is an important predictor of outcome.
  • NADT appears to benefit patients who presented with a pre-radiotherapy PSA level > 0.2 ng/ml, particularly for patients receiving SRT.
  • NADT can be considered for patients receiving radiotherapy after RP who present with a high pre-radiotherapy PSA level, but may not be necessary for patients with a low PSA level.

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