title: Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer.
abstract: BACKGROUND
  Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.
  
  
  METHODS
  Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml(-1) were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.
  
  
  RESULTS
  Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).
  
  
  CONCLUSIONS
  Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.
authors.affiliation: Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Zurita
authors.affiliation: Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Pisters
authors.affiliation: Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Troncoso
authors.affiliation: Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Dieringer
authors.affiliation: Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Ward
authors.affiliation: Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Davis
authors.affiliation: Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Pettaway
authors.affiliation: Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Logothetis
authors.affiliation: Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Pagliaro
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen