title: Both radical prostatectomy following treatment with neoadjuvant LHRH agonist and estramustine and radiotherapy following treatment with neoadjuvant hormonal therapy achieved favorable oncological outcome in high-risk prostate cancer: a propensity-score matching analysis.
abstract: BACKGROUND
  To date, the different treatment modalities for high-risk prostate cancer (Pca) have not been compared in any sufficiently large-scale, prospective, randomized clinical trial. We used propensity-score matching analysis to compare the oncological outcomes of high-risk prostate cancer between patients treated with radical prostatectomy (RP) and those treated with radiation therapy (RT).
  
  
  METHODS
  We studied 216 patients who received neoadjuvant therapy followed by RP (RP cohort) and 81 patients who received neoadjuvant androgen-deprivation therapy (ADT) followed by RT (RT cohort). The RP cohort received a luteinizing hormone-releasing hormone agonist and estramustine phosphate (280 mg/day) for 6 months prior to RP. The RT cohort received ADT for at least 6 months prior to RT using a 3-dimensional conformal radiotherapy technique. The total radiation dose was 70 to 76 Gy administered at 2 Gy/fraction.
  
  
  RESULTS
  Propensity-score matching identified 78 matched pairs of patients. The 3-year overall survival rates were 98.3% and 92.1% in the RP and RT groups, respectively (P=0.156). The 3-year biochemical recurrence-free survival rates were 86.4% and 89.4% in the RP and RT groups, respectively (P=0.878).
  
  
  CONCLUSIONS
  Our study findings may suggest almost identical cancer control of RP and RT with appropriate neoadjuvant therapy in high-risk Pca. Therefore, issues of health-related quality of life may have an important impact on decision making in treatment of high-risk Pca.
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan. coyama@cc.hirosaki-u.ac.jp.
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imai
authors.forename: Shingo
authors.initials: S
authors.lastname: Hatakeyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Tohru
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tobisawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Aoki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takai
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004961:Estramustine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000819:agonists; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D057216:Propensity Score; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D004961:Estramustine