Results of radiation therapy combined with neoadjuvant hormonal therapy for stage III prostate cancer: comparison of two different definitions of PSA failure.
BACKGROUND
We herein report the clinical outcome of radical radiation therapy combined with neoadjuvant hormonal therapy (NHT) for stage III (International Union Against Cancer [UICC] 1997: UICC 97) prostate cancer. Prostate-specific antigen (PSA) failure-free survival was assessed according to two different definitions, and the appropriateness of each definition is discussed.


METHODS
Between October 1997 and December 2000, 27 patients with stage III prostate cancer were enrolled in this study. The median pretreatment PSA level was 29 ng/ml (range, 7.4-430 ng/ml). The Gleason score (GS) was 7 or more in 22 patients (81%). All patients received 3 months of NHT with a luteinizing hormone-releasing hormone (LH-RH) analogue, in combination with an antiandrogen (flutamide), given during the first 2 weeks, followed by 70-Gy external-beam radiation therapy (EBRT) in 35 fractions. The initial 46 Gy was given with a four-field technique, while the remainder was given with a dynamic conformal technique. No adjuvant hormonal therapy (AHT) was given.


RESULTS
The median follow-up time was 63 months. PSA levels decreased to the normal range (<4 ng/ml) after irradiation in all but one patient. The 5-year PSA failure-free survival was 34.8% according to the American Society for Therapeutic Radiology and Oncology (ASTRO) definition and it was 43.0% according to the "nadir plus 2" definition. Discordance of the results between the two definitions was seen in two patients. The 5-year overall and cause-specific survivals were 83.0% and 93.3%, respectively. No severe acute or late adverse effects were observed.


CONCLUSIONS
Seventy Gy of EBRT following 3 months of NHT produced therapeutic results comparable to those reported in other studies which used long-term AHT. The value of long-term AHT for Japanese men should be tested in a clinical trial.
Mitsumori
Michihide
M
Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 85 Shogoin-Kawara-machi, Sakyo-ku, Kyoto, 606-8507, Japan. mitsumo@kuhp.kyoto-u.ac.jp
Sasaki
Yoshihide
Y
Mizowaki
Takashi
T
Takayama
Kenji
K
Nagata
Yasushi
Y
Hiraoka
Masahiro
M
Negoro
Yoshiharu
Y
Sasai
Keisuke
K
Kinoshita
Hidefumi
H
Kamoto
Toshiyuki
T
Ogawa
Osamu
O
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005485:Flutamide / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis
D000726:Androgen Antagonists; D014408:Biomarkers, Tumor; D007987:Gonadotropin-Releasing Hormone; D005485:Flutamide; D017430:Prostate-Specific Antigen