Long-term Follow-up Of Androgen Deprivation In Combination With Radiotherapy Versus Radiotherapy Alone

UroToday.com - Androgen deprivation in combination with radiotherapy is routinely used as treatment for intermediate and high-risk prostate cancer (CaP). Most series do not have surgical staging of pelvic lymph nodes prior to therapy. Dr. Granfors and colleagues report an update of their original series (J Urol 1998;159:2030) in the Journal of Urology, August 2006 issue.

From 1986-1991, 91 patients with newly diagnosed CaP underwent radiographic staging and surgical pelvic lymphadenectomy. They were then randomized to 65Gy of radiotherapy alone (RT group) or androgen deprivation (orchiectomy) with radiotherapy (A plus RT). Participants in the RT group received androgen deprivation at the time of clinically evident progression. Mean follow-up was 9.7 years in all patients and 16.5 years in survivors.

By April 2005, 74 patients (81%) had died, 42 from CaP (57%). Prostate cancer mortality was 57% in the RT arm and 36% in the A plus RT arm. Overall cumulative survival favored A plus RT. In initial lymph node negative (N0) cases, the differences in overall survival rate between the treatment arms were not statistically significant. In patients who had lymph node positive (N+) CaP, overall survival was better in the A plus RT patients. In the RT group with N0 disease, prognosis was better than those with N1 disease. In the A plus RT group, there was no difference. In this updated report, the difference between the 2 groups in cancer specific survival has achieved statistical significance.

This updated data suggests that androgen deprivation in combination with RT is appropriate therapy for men with N+ prostate cancer. A limitation is that one does not know the potential outcome if men had been treated with androgen deprivation alone.

By Christopher P. Evans, M.D.

J Urol 2006;176:544-547
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