Abstract
Purpose
Primary ADT (pADT) monotherapy is used significantly for patients with clinically localised disease in Asia and is acceptable even by guidelines, especially in intermediate- and high-risk disease. This occurs despite controversy in the West and data suggesting association with adverse effects, notably cardiovascular events. We therefore sought to assess the impact of pADT on all-cause mortality and prostate cancer-specific mortality (PCSM) in Asian men with high-risk and unfavourable intermediate-risk PCa.
Methods
With cancer registry data, men from a single centre in Singapore with clinically localised high-risk/unfavourable intermediate-risk PCa diagnosed between 2004 and 2014 and either treated conservatively with no therapy or started on pADT within 1 year of diagnosis were followed up through January 2017. Patients with non-localised PCa (clinical stage T4, regional/distant lymph node involvement, metastases), or receipt of local therapy (radical prostatectomy/radiotherapy) were excluded. The primary outcomes of all-cause mortality and PCSM were analysed with Cox proportional hazards regression models.
Results
Three hundred and forty Asian men were analysed, and 177 (52.1%) were started on pADT, with mean age of 77 (49–98) years. There were 119 deaths in the cohort, and 68 (38.4%) occurred in patients treated with pADT (median follow-up, 4.4 years). After adjusting for comorbidities and clinical characteristics, pADT did not provide benefit to all-cause mortality, PCSM or cardiovascular mortality.
Conclusion
For clinically localised unfavourable intermediate-risk and high-risk PCa, starting pADT within 12 months of diagnosis is not associated with improved 5-year all-cause mortality or PCSM compared to patients treated conservatively with no therapy and should be discouraged due to lack of mortality benefit.
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References
Center MM, Jemal A, Lortet-Tieulent J et al (2012) International variation in prostate cancer incidence and mortality rates. Eur Urol 61:1079–1092
Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council Trial (1997) The Medical Research Council Prostate Cancer Working Party Investigators Group. Br J Urol 79:235–246
Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E et al (2007) Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 25:1596–1605
Messing EM, Manola J, Sarosdy M et al (1999) Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 341:1781–1788
Jones CU, Hunt D, McGowan DG et al (2011) Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med 365:107–118
Lu-Yao GL, Albertsen PC, Moore DF et al (2008) Survival following primary androgen deprivation therapy among men with localized prostate cancer. JAMA 300:173–181
Tanaka N, Fujimoto K, Hirayama A et al (2010) Trends of the primary therapy for patients with prostate cancer in Nara Uro-Oncological Research Group (NUORG): a comparison between the CaPSURE data and the NUORG data. Jpn J Clin Oncol 40:588–592
Kapoor D, Malkin CJ, Channer KS, Jones TH (2005) Androgens, insulin resistance and vascular disease in men. Clin Endocrinol (Oxf) 63(3):239–250
D’Amico AV, Denham JW, Crook J et al (2007) Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol 25(17):2420–2425
Cooperberg M, Hinotsu S, Namiki M et al (2016) Trans-pacific variation in outcomes for men treated with primary androgen-deprivation therapy (ADT) for prostate cancer. BJU Int 117:102–109
Fukagai T, Namiki ST, Carlile R, Yoshida H, Namiki M (2006) Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men. BJU Int 97:1190–1193
National Comprehensive Cancer Network Guidelines Asia Consensus for Prostate Cancer. http://demo.nccn.org/professionals/physician_gls/PDF/prostate-asia.pdf
D’Amico AV, Whittington R, Malkowicz S et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy or, interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974. https://doi.org/10.1001/jama.280.11.969
Zumsteg ZS, Spratt DE, Pei I et al (2013) A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy. Eur Urol 64:895–902
Charlson MEM (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373
Sammon J, Abdollah F, Reznor G et al (2015) Patterns of declining use and the adverse effects if primary androgen deprivation therapy on all-cause mortality in elderly men with prostate cancer. Eur Urol 68:32–39
Lu-Yao GL, Albertsen PC, Moore DF et al (2014) Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer. JAMA 174(9):1460–1467
Potosky AL, Haque R, Cassidy-Bushrow AE et al (2014) Effectiveness of primary androgen-deprivation therapy for clinically localized prostate cancer. J Clin Oncol 32:1324–1330
Studer UE, Whelan P, Wimpissinger F et al (2014) 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 66:829–838
Wong YN, Freedland SJ, Egleston B et al (2009) The role of primary androgen deprivation therapy in localized prostate cancer. Eur Urol 56:609–616
Akaza H, Homma Y, Okada K et al (2003) A prospective and randomized study of primary hormonal therapy for patients with localized or locally advanced prostate cancer unsuitable for radical prostatectomy: results of the 5-year follow-up. BJU Int 91:33–36
Akaza H, Homma Y, Usami M et al (2006) Efficacy of primary hormone therapy for localized or locally advanced prostate cancer: results of a 10-year follow-up. BJU Int 98:573–579
Matsumoto K, Hagiwara M, Tanaka N et al (2014) Survival following primary androgen deprivation therapy for localized intermediate- or high-risk prostate cancer: comparison with the life expectancy of the age-matched normal population. Med Oncol 31:979
Akaza H, Hirao Y, Kim CS, Oya M, Ozono S, Ye D et al (2016) Asia prostate cancer study (A-CaP) launch symposium. Prostate Int 4:88–96
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in this study.
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Lee, H.J., Lee, A., Huang, H.H. et al. Primary androgen deprivation therapy as monotherapy in unfavourable intermediate- and high-risk localised prostate cancer: a Singaporean single-centre perspective. Int Urol Nephrol 50, 665–673 (2018). https://doi.org/10.1007/s11255-018-1802-4
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DOI: https://doi.org/10.1007/s11255-018-1802-4