To clarify which subset of stage IV prostate cancer patients benefit from combined androgen blockade (CAB) using Japanese nationwide database.
A total of 3,752 patients with stage IV disease from the prospective nationwide cohort database of the Japan Study Group of Prostate Cancer (J-CaP) were enrolled. All patients started primary androgen deprivation therapy (PADT) between 2001 and 2003, and the present study was performed using the data set from December 2011. Patients were divided into two groups according to initial treatments: CAB with luteinizing hormone-releasing hormone agonist (LHRH) plus anti-androgen (AA) and non-CAB treatments such as LHRH monotherapy. The overall survival (OS) and cancer-specific survival (CSS) for each group were estimated by the Kaplan–Meier method.
A total of 2,967 patients (79.1 %) received CAB. Overall, no significant difference was observed in OS and CSS between the CAB group and the non-CAB group. However, CAB resulted in significantly better OS and CSS compared to non-CAB in patients with very high Japan Cancer of the Prostate Risk Assessment (J-CAPRA) scores of ten or greater (P = 0.007 and 0.013, respectively). Multivariate analysis revealed that CAB was an independent predictive factor for better OS (P = 0.013, hazard ratio = 0.83).
Based on large-scale nationwide database, as PADT for prostate cancer patients with very high-risk disease, CAB resulted in better OS than other endocrine treatments.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Akaza H, Usami M, Hinotsu S et al (2004) Characteristics of patients with prostate cancer who have initially been treated by hormone therapy in Japan: J-CaP surveillance. Jpn J Clin Oncol 34:329–336
Akaza H, Hinotsu S, Usami M et al (2009) Combined androgen blockade with bicalutamide for advanced prostate cancer: long-term follow-up of a phase 3, double-blind, randomized study for survival. Cancer 115:3437–3445
Akaza H, Hinotsu S, Usami M et al (2013) Evaluation of primary androgen deprivation therapy in prostate cancer patients using the J-CAPRA risk score. Prostate Int 1:81–88
Albertsen PC, Klotz L, Tombal B et al (2014) Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist. Eur Urol 65:565–573
Baade PD, Youlden DR, Cramb SM et al (2013) Epidemiology of prostate cancer in the Asia-Pacific region. Prostate Int 1:47–58
Center MM, Jemal A, Lortet-Tieulent J et al (2012) International variation in prostate cancer incidence and mortality rates. Eur Urol 61:1079–1092
Cooperberg MR, Hinotsu S, Namiki M et al (2009) Risk assessment among prostate cancer patients receiving primary androgen deprivation therapy. J Clin Oncol 27:4306–4313
Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ (1989) A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med 321(7):419–424. Erratum in: N Engl J Med 321(20):1420
de Bono JS, Oudard S, Ozguroglu M et al (2010) TROPIC investigators. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomized open-label trial. Lancet 376:1147–1154
Fujimoto H, Nakanishi H, Miki T et al (2011) Oncological outcomes of the prostate cancer patients registered in 2004: report from the Cancer Registration Committee of the JUA. Int J Urol 18:876–881
Fukagai T, Namiki TS, Carlile RG et al (2006) Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men. BJU Int 97:1190–1193
Hinotsu S, Akaza H, Usami M et al (2007) Current status of endocrine therapy for prostate cancer in Japan analysis of primary androgen deprivation therapy on the basis of data collected by J-CaP. Jpn J Clin Oncol 37:775–781
Hong GE, Kong CH, Singam P et al (2010) Seven-year review of prostate carcinomas diagnosed by TRUS biopsy in a single Malaysian institution. Asian Pac J Cancer Prev 11:1351–1353
Hsiao W, Moses KA, Goodman M et al (2010) Stage IV prostate cancer: survival differences in clinical T4, nodal and metastatic disease. J Urol 184:512–518
Kimura T, Onozawa M, Miyazaki J et al (2013) Validation of the prognostic grouping of the seventh edition of the tumor-nodes-metastasis classification using a large-scale prospective cohort study database of prostate cancer treated with primary androgen deprivation therapy. Int J Urol 20:880–888
Klotz L, Schellhammer P, Carroll K (2004) A re-assessment of the role of combined androgen blockade for advanced prostate cancer. BJU Int 93:1177–1182
Matsuda A, Matsuda T, Shibata A et al (2013) Cancer incidence and incidence rates in Japan in 2007: a study of 21 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 43:328–336
Ministry of Health, Labour and Welfare. (2012) Vital statistics of Japan. http://www.mhlw.go.jp/english/database/db-hw/index.html. Accessed 10 June 2013
Nguyen QN, Levy LB, Lee AK et al (2013) Long-term outcomes for men with high-risk prostate cancer treated definitively with external beam radiotherapy with or without androgen deprivation. Cancer 119:3265–3271
Onukwugha E, Mullins CD, Hsu VD et al (2013) Effect of urologists and medical oncologists on treatment of elderly men with Stage IV prostate cancer. Urology 77:1088–1095
Prostate Cancer Trialists’ Collaborative Group (2000) Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Lancet 355:1491–1498
Samson DJ, Seidenfeld J, Schmitt B et al (2002) Systematic review and meta-analysis of monotherapy compared with combined androgen blockade for patients with advanced prostate carcinoma. Cancer 95:361–376
Schmitt B, Wilt TJ, Schellhammer PF et al (2001) Combined androgen blockade with nonsteroidal antiandrogens for advanced prostate cancer: a systematic review. Urology 57:727–732
Shao Q, Ouyang J, Fan Y et al (2012) Prostate cancer in the senior men from rural areas in east district of China: contemporary management and 5-year outcomes at multi-institutional collaboration. Cancer Lett 315:170–177
Studer UE, Whelan P, Wimpissinger F et al (2013) Differences in time to disease progression do not predict for Cancer-specific survival in patients receiving immediate or deferred androgen-deprivation therapy for prostate Cancer: final results of EORTC randomized trial 30891 with 12 Years of follow-up. Eur Urol. Epub ahead of print. doi:10.1016/j.eururo.2013.07.024
Walz J, Joniau S, Chun FK et al (2011) Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy. BJU Int 107:765–770
Ward JF, Slezak JM, Blute ML et al (2005) Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 95:751–756
Conflict of interest
The authors have no potential conflicts of interest to declare.
About this article
Cite this article
Matsuoka, T., Kawai, K., Kimura, T. et al. Long-term outcomes of combined androgen blockade therapy in stage IV prostate cancer. J Cancer Res Clin Oncol 141, 759–765 (2015). https://doi.org/10.1007/s00432-014-1856-3
- Prostate cancer
- Primary androgen deprivation therapy
- Combined androgen blockade
- Stage IV