title: Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: a propensity score-matched analysis.
abstract: BACKGROUND
  The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with a neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). In the present study, we used a retrospective design via propensity score matching to elucidate the clinical benefit of neoadjuvant LHRH+EMP for high-risk Pca.
  
  
  METHODS
  The Michinoku Urological Cancer Study Group database contained data for 1,268 consecutive Pca patients treated with RP alone at 4 institutions between April 2000 and March 2011 (RP alone group). In the RP alone group, we identified 386 high-risk Pca patients. The neoadjuvant LHRH+EMP group included 274 patients with high-risk Pca treated between September 2005 and November 2013 at Hirosaki University. Neoadjuvant LHRH+EMP therapy included LHRH and EMP administration at a dose of 280 mg/day for 6 months before RP. The outcome measures were overall survival (OS) and BRFS.
  
  
  RESULTS
  The propensity score-matched analysis indicated 210 matched pairs from both groups. The 5-year BRFS rates were 90.4 and 65.8 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P < 0.0001). The 5-year OS rates were 100 and 96.1 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P = 0.110).
  
  
  CONCLUSIONS
  Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP appeared to reduce the risk of biochemical recurrence. A prospective randomized study is warranted to determine the clinical implications of the neoadjuvant therapy described here.
authors: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan. goodwin@cc.hirosaki-u.ac.jp.
authors: Takuya
authors: T
authors: Koie
authors: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Koji
authors: K
authors: Mitsuzuka
authors: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors: Takahiro
authors: T
authors: Yoneyama
authors: Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
authors: Shintaro
authors: S
authors: Narita
authors: Department of Urology, Miyagi Cancer Center, Natori, Japan.
authors: Sadafumi
authors: S
authors: Kawamura
authors: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Yasuhiro
authors: Y
authors: Kaiho
authors: Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
authors: Norihiko
authors: N
authors: Tsuchiya
authors: Department of Urology, Miyagi Cancer Center, Natori, Japan.
authors: Tatsuo
authors: T
authors: Tochigi
authors: Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
authors: Tomonori
authors: T
authors: Habuchi
authors: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Yoichi
authors: Y
authors: Arai
authors: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors: Chikara
authors: C
authors: Ohyama
authors: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors: Tohru
authors: T
authors: Yoneyama
authors: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors: Yuki
authors: Y
authors: Tobisawa
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D004961:Estramustine / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000008:administration & dosage*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D057216:Propensity Score; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D004961:Estramustine; D017430:Prostate-Specific Antigen; D016729:Leuprolide
keywords: High-risk prostate cancer; LHRH plus estramustine; Neoadjuvant therapy; Propensity score analysis; Prostatectomy