Cessation of long-term adjuvant androgen deprivation therapy after radical prostatectomy: is it feasible?
BACKGROUND
Adjuvant androgen deprivation therapy is a common treatment option for prostate cancer after radical prostatectomy, especially in Asia. However, no study has investigated the oncological outcome after cessation of long-term adjuvant androgen deprivation therapy with favorable prostate-specific antigen  control.


METHODS
Among 855 patients undergoing radical prostatectomy at our institution between 2000 and 2012, we identified 56 men with pT2-4N0-1M0 prostate cancer who had received long-term (>2 years) adjuvant androgen deprivation therapy after radical prostatectomy and subsequently stopped it under a condition of continued prostate-specific antigen values <0.1 ng/mL. The oncological outcome was evaluated using biochemical recurrence, defined as two consecutive prostate-specific antigen values ≥0.2 ng/mL, as the primary endpoint. Cox proportional hazards model was used for multivariate analysis. Age at androgen deprivation therapy cessation was dichotomized as <68 years and ≥68 years, based on the most discriminatory cutoff.


RESULTS
Median duration of adjuvant androgen deprivation therapy was 70 months. Overall, 13 of 56 (23%) patients developed biochemical recurrence with a median follow-up period of 41 months after androgen deprivation therapy cessation. Multivariate analysis identified age at androgen deprivation therapy cessation <68 years and pN1 as independent predictors of biochemical recurrence. Predisposition of younger age to poorer survival may be related to more frequent testosterone recovery in younger men (73 vs 33%, P = 0.0299). One patient had evidence of clinical metastasis and no one died of prostate cancer.


CONCLUSIONS
Androgen deprivation therapy cessation would be feasible in most men who received long-term adjuvant androgen deprivation therapy after radical prostatectomy with favorable prostate-specific antigen control. Risk factors of biochemical recurrence after androgen deprivation therapy cessation included younger age at androgen deprivation therapy cessation and pN1.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Satoru
S
Taguchi
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo hfukuhara-jua@umin.ac.jp.
Hiroshi
H
Fukuhara
Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Teppei
T
Morikawa
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Akihiko
A
Matsumoto
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Hideyo
H
Miyazaki
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Tohru
T
Nakagawa
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Tetsuya
T
Fujimura
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Haruki
H
Kume
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Yasuhiko
Y
Igawa
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo.
Yukio
Y
Homma
D000276:Adjuvants, Immunologic; D000367:Age Factors; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D028761:Withholding Treatment
D000276:Adjuvants, Immunologic; D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
androgen deprivation; cessation; prostate cancer; prostatectomy; testosterone