Surgically managed lymph node-positive prostate cancer: does delaying hormonal therapy worsen the outcome?
OBJECTIVE
To review our experience with the surgical management of lymph node-positive prostate cancer and to determine if there is a benefit to treating such patients with immediate rather than delayed hormonal therapy (HT).


METHODS
A retrospective analysis from January 1982 to January 2001 identified 100 patients treated by radical retropubic prostatectomy (RP) either alone (70, 23 later received delayed HT) or combined with adjuvant (immediate) HT (30), with the overall median follow-up being 5.2 years.


RESULTS
The median patient age at diagnosis was 58.7 years, with 20% having clinical T3 disease, and the median prostate specific antigen (PSA) level at presentation was 10 ng/mL. In 41% of patients the Gleason score on prostatic biopsy was > or = 8. After RP, 30 patients received immediate HT used as an adjuvant after surgery in the absence of any evidence of disease progression, whereas 23 received delayed HT the use of which was provoked secondary to biochemical failure (PSA threshold of 0.2-5.0 ng/mL) with no evidence of metastatic disease. A comparison of the clinical variables between the groups showed a higher median PSA level at diagnosis (P = 0.027) and biopsy Gleason score (P = 0.052) in the delayed HT group. The immediate and delayed HT groups had similar metastatic-free (P = 0.549), disease-specific (P = 0.843) and overall survival (P = 0.843). Overall, biochemical failure developed in half the patients and distant metastasis in 13%, with only nine patients dying from disease.


CONCLUSIONS
Immediate and delayed HT provide similar treatment outcomes in patients with surgically managed lymph node-positive prostate cancer.
Spiess
Philippe E
PE
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Lee
Andrew K
AK
Busby
Joseph E
JE
Jordan
Jennifer J
JJ
Hernandez
Mike
M
Burt
Kristina
K
Troncoso
Patricia
P
Merriman
Kelly W
KW
Pisters
Louis L
LL
D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen