Impact of hormonal therapy on intermediate risk prostate cancer treated with combination brachytherapy and external beam irradiation.
OBJECTIVE
We assessed the impact of androgen suppressive therapy on biochemical failure in patients with intermediate risk prostate cancer treated with brachytherapy and external beam irradiation.


METHODS
From 1994 to 2006, 432 patients with intermediate risk prostate cancer as defined by the National Comprehensive Cancer Network were treated with low dose rate brachytherapy and external beam irradiation with or without 9 months of androgen suppressive therapy. Gleason score was 7 in 76% of cases and prostate specific antigen was 1.4 to 20 ng/ml (median 7.6). Of the patients 350 received androgen suppressive therapy and 82 did not. The biologically effective dose was 142 to 280 Gy2 (median 206). Followup was 23 to 155 months (median 56).


RESULTS
The overall 8-year biochemical failure-free rate using the Phoenix definition in patients with vs without androgen suppressive therapy was 92% vs 92% (p = 0.4). The therapy had no significant impact on the biochemical failure-free rate in patients with Gleason score 7 (92% vs 90.5%, p = 0.55), prostate specific antigen 10 to 20 ng/ml (92% vs 100%, p = 0.32), T2b-T2c disease (89.5% vs 97%, p = 0.27) and more than 1 intermediate risk feature (90% vs 100%, p = 0.2).


CONCLUSIONS
We addressed the relative importance of radiation dose vs hormonal therapy for intermediate risk prostate cancer. With high biologically effective dose combination treatment androgen suppressive therapy did not have a significant impact on the 8-year biochemical failure-free rate. We question its routine use in this setting.
Stock
Richard G
RG
Department of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, New York 10025, USA. richard.stock@mountsinai.org
Yalamanchi
Swati
S
Yamalachi
Swati
S
Hall
Simon J
SJ
Stone
Nelson N
NN
D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D012189:Retrospective Studies; D012307:Risk Factors
D000726:Androgen Antagonists