Premium
Clinical outcomes of androgen deprivation as the sole therapy for localized and locally advanced prostate cancer
Author(s) -
Janoff Daniel M.,
Peterson Chad,
MongoueTchokote Solange,
Peters Laura,
Beer Tomasz M.,
Wersinger Emily M.,
Mori Motomi,
Garzotto Mark
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05674.x
Subject(s) - medicine , prostate cancer , androgen deprivation therapy , hazard ratio , prostate specific antigen , rectal examination , univariate analysis , urology , prostate , oncology , confidence interval , cancer , multivariate analysis
Most papers in this section are written about various aspects of prostate cancer, and cover a wide cross‐section of subjects relating to this important topic. Interestingly there has been increasing interest by clinical oncologists in this area, and I am delighted to publish their views in this Journal. We as urologists now routinely have multidisciplinary team meetings, and find the insightful comments of the non‐urologists very helpful in the management not only of patients with prostate cancer, but also of all types of urological malignancy. OBJECTIVE To characterize the clinical outcomes of androgen deprivation therapy (ADT) as the sole therapy for localized prostate cancer, and to determine independent predictors of disease progression, as recent studies indicate an increasing use of ADT. PATIENTS AND METHODS The records of all patients with cT1–4NXM0 adenocarcinoma of the prostate treated with ADT as the primary initial therapy at the Portland Veterans Affairs Medical Center between 1993 and 2000 were reviewed. Age, race, Charlson Health Index, family history, prostate‐specific antigen (PSA) level, PSA density, digital rectal examination (DRE) findings, Gleason score, and percentage of positive biopsy cores at diagnosis were recorded for 81 patients. Patients had a median ( sd , range) age of 73 (5.6, 58–84) years, a PSA level of 14.3 (34.6, 1.4–252) ng/mL and tumours were classified as Gleason score ≤ 5 in 9% of patients, 6 in 31%, 7 in 31% and 8–10 in 30%. Outcomes extracted were PSA progression, PSA nadir, bone fractures, local progression, distant progression and overall survival. RESULTS With a median (range) follow‐up of 54 (6–115) months, the incidence of local progression, distant progression, bone fractures, PSA progression, and death were 10%, 7%, 25%, 21% and 41% respectively. The percentage of positive biopsy cores ≥ 83%, age < 70 years, Gleason score ≥ 7, abnormal DRE, and PSA nadir ≥ 0.2 ng/mL were significantly associated with PSA progression by univariate analysis. The multivariate analysis identified age < 70 years (hazard ratio 6.52, 95% confidence interval 2.29–18.55) and Gleason score ≥ 6 (4.0, 2.0–12.0) as independent risk factors for PSA progression. CONCLUSIONS ADT resulted in modest control of localized prostate cancer, but younger patients and those with Gleason ≥ 6 cancers were at higher risk of treatment failure. Toxicity, principally in the form of bone fractures, was high.