Factors associated with improved biochemical response to neoadjuvant androgen deprivation therapy before definitive radiation therapy in prostate cancer patients

• Published in: Prostate cancer and prostatic diseases Vol. 16; no. 4; pp. 346 - 351
• Main Authors: Cerne, J Z, McGuire, S E, Grant, S R, Munsell, M F, Lee, A K, Kudchadker, R J, Choi, S L, Mahmood, U, Hoffman, K E, Pugh, T J, Frank, S J, Kuban, D A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2013; Nature Publishing Group
• Subjects: 692/53/2423; 692/699/67/1059/485; 692/699/67/589/466; 692/700/565/238; Ablation; African Americans; Aged; Aged, 80 and over; Androgen Antagonists - therapeutic use; Androgens; Antineoplastic Agents, Hormonal - therapeutic use; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer therapies; Care and treatment; Clinical trials; Deprivation; Genetic aspects; Health risks; Hormone therapy; Humans; Luteinizing hormone; Luteinizing hormone-releasing hormone; Male; Middle Aged; Multivariate analysis; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; original-article; Patient outcomes; Patients; Prostate cancer; Prostate-Specific Antigen - genetics; Prostate-Specific Antigen - metabolism; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - metabolism; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radiation; Radiation therapy; Risk; Risk Factors; Risk groups; Treatment Outcome; Tumors; neoadjuvant androgen deprivation therapy; high-risk; biochemical response; radiation therapy; intermediate-risk
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/pcan.2013.26

Background: In prostate cancer patients treated with androgen deprivation therapy (ADT) and radiation therapy (RT), a pre-RT PSA level ⩾0.5 ng ml −1 , determined after neoadjuvant ADT and before RT, predicts for worse survival measures. The present study sought to identify patient, tumor and treatment characteristics associated with the pre-RT PSA in prostate cancer patients. Methods: We reviewed the charts of all patients diagnosed with intermediate- and high-risk prostate cancer and treated with a combination of neoadjuvant (median, 2.2 and 2.5 months, respectively), concurrent, and adjuvant ADT and RT between 1990 and 2011. Results: A total of 170 intermediate- and 283 high-risk patients met inclusion criteria. On multivariate analysis, both intermediate- and high-risk patients with higher pre-treatment PSA (iPSA) were significantly less likely to achieve a pre-RT PSA <0.5 ng ml −1 (iPSA 10.1–20 ng ml −1 : P =0.005 for intermediate risk; iPSA 10.1–20 ng ml −1 : P =0.005, iPSA >20 ng ml −1 : P <0.001 for high risk). High-risk patients undergoing total androgen blockade were more likely to achieve a pre-RT PSA <0.5 ng ml −1 ( P =0.031). We observed an interaction between race and type of neoadjuvant ADT ( P =0.074); whereas African-American men on total androgen blockade reached pre-RT PSA <0.5 ng ml −1 as frequently as other men on total androgen blockade ( P =0.999), African-American men on luteinizing hormone-releasing hormone (LH-RH) agonist monotherapy/orchiectomy were significantly less likely to reach pre-RT PSA <0.5 ng ml −1 compared with other men on LH-RH monotherapy/orchiectomy ( P =0.001). Conclusions: Our findings suggest that total androgen blockade in the neoadjuvant period may be beneficial compared with LH-RH monotherapy for achieving a pre-RT PSA <0.5 ng ml −1 in African-American men with high-risk prostate cancer. In addition, men with higher iPSA are more likely to have a pre-RT PSA greater than 0.5 ng ml −1 in response to neoadjuvant ADT and are therefore candidates for clinical trials testing newer, more aggressive hormone-ablative therapies.