Immediate, adjuvant ADT after surgery does not significantly affect ...

Posted on January 28, 2013 by Sitemaster

For many years, physicians at the Mayo Clinic in Rochester, MN, have been offering immediate, adjuvant androgen deprivation therapy (ADT) to some of their surgical patients with more advanced and high-risk forms of prostate cancer. The assumption had been that early use of ADT among such patients might have a significant survival benefit.

Linder et al. have now published a detailed, retrospective analysis of the outcomes of 1,247 men, all treated by radical prostatectomy for high-risk prostate cancer between 1988 and 2004. High-risk disease was defined by the criteria of the National Comprehensive Cancer Network and therefore implied at least one of the following: clinical stage ? T3a or a Gleason score of ? 4 + 4 = 8 or a PSA level > 20 ng/ml. All patients were also categorized by comorbidity status through the use of the Charlson comorbidity index.

The investigators? intent was to evaluate whether the use of immediate, adjuvant ADT had any beneficial impact on overall or prostate cancer-specific survival when the patients were stratified by comorbidity status.

Here is what they found:

• 419/1,247 patients (33.6 percent) were treated with immediate, adjuvant ADT after surgery.
• 828/1,247 patients (66.4 percent) were not treated with immediate, adjuvant ADT after surgery.
• The average (median) age of the patients was 65 years.
• 816/1,247 patients (65.4 percent) had a Charlson comorbidity index of 0.
• 244/1,247 patients (19.6 percent) had a Charlson comorbidity index of 1.
• 142/1,247 patients (11.4 percent) had a Charlson comorbidity index of 2.
• The 10-year overall survival data for the patients, when stratified by Charlson comorbidity index, was as follows:
  • 75 percent for men with a Charlson score of 0 who received immediate, adjuvant ADT.
  • 82 percent for men with a Charlson score of 0 who did not receive immediate, adjuvant ADT.
  • 72 percent for men with a Charlson score of 1 who received immediate, adjuvant ADT.
  • 76 percent for men with a Charlson score of 1 who did not receive immediate, adjuvant ADT.
  • 70 percent for men with a Charlson score of ? 2 who received immediate, adjuvant ADT.
  • 68 percent for men with a Charlson score of ? 2 who did not receive immediate, adjuvant ADT.
  • None of these differences is statistically significant.
• 155/1,247 patients (1.4 percent) had cardiovascular disease.
• The 10-year overall survival for patients with cardiovascular disease was as follows:
  • 72 percent for men who received immediate, adjuvant ADT.
  • 76 percent for men who did not receive immediate, adjuvant ADT.
  • This difference, again, was not statistically significant
• On multivariate analysis, receipt of immediate, adjuvant hormonal therapy ADT post-prostatectomy was not associated with non-prostate cancer mortality (P?=?0.24).

The authors conclude that, in their long series of patients with high-risk disease, the use of immediate, adjuvant ADT? after radical prostatectomy does not increase the probability of death from something other than prostate cancer ? even when the patients have multiple comorbidities.

Now it has to be remembered that this was an open study of a series of patients, not a clinical trial, and that the analysis is retrospective as opposed to prospective, so one would be wise not to over-interpret the results presented above. On the other hand, there is little to no indication from this series of data that early use of ADT in high-risk men after radical prostatectomy even might be capable of inducing a meaningful survival benefit.

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Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment Tagged: | "high risk", adjuvant, ADT, androgen, deprivation, radical prostatectomy

Source: http://prostatecancerinfolink.net/2013/01/28/immediate-adjuvant-adt-after-surgery-does-not-signifciantly-affect-survival-if-high-risk-men/

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