title: Mortality and Androgen Deprivation Therapy as Salvage Treatment for Biochemical Recurrence after Primary Therapy for Clinically Localized Prostate Cancer.
abstract: Androgen deprivation therapy is often used as salvage treatment in men with rising prostate specific antigen after initial radical prostatectomy or radiotherapy for clinically localized prostate cancer. Given the lack of evidence from general practice, we examined the association of salvage androgen deprivation therapy with mortality in an observational cohort study.
  
  
  
  From 3 managed care organizations we assembled a retrospective cohort of all 5,804 men with newly diagnosed localized prostate cancer from 1995 to 2009 who had a prostate specific antigen increase (biochemical recurrence) after primary radical prostatectomy or radiotherapy. The main outcomes were all-cause and prostate cancer specific mortality. We used Cox proportional hazards models to estimate mortality with salvage androgen deprivation therapy as a time dependent predictor.
  
  
  
  Overall salvage androgen deprivation therapy was not associated with all-cause or prostate cancer specific mortality in the prostatectomy cohort (HR 0.97, 95% CI 0.70-1.35 or HR 1.18, 95% CI 0.68-2.07) or in the radiotherapy cohort (HR 0.84, 95% CI 0.70-1.01 or HR 1.06, 95% CI 0.80-1.40, respectively). Among men with prostate specific antigen doubling time less than 9 months after the prostate specific antigen rise, salvage androgen deprivation therapy was statistically significantly associated with a decreased risk of all-cause and prostate cancer specific mortality in the prostatectomy cohort (HR 0.35, 95% CI 0.20-0.63 and HR 0.43, 95% CI 0.21-0.91) and in the radiotherapy cohort (HR 0.62, 95% CI 0.48-0.80 and HR 0.65, 95% CI 0.47-0.90, respectively).
  
  
  
  We found no association of salvage androgen deprivation therapy with all-cause or cause specific mortality in most men with biochemical recurrence after primary radical prostatectomy or radiotherapy for clinically localized prostate cancer. Men with quickly progressed disease may derive a clinical benefit from salvage androgen deprivation therapy.
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.. Electronic address: zf54@georgetown.edu.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
authors.forename: Huei-Ting
authors.initials: HT
authors.lastname: Tsai
authors.affiliation: Southern California Permanente Medical Group, Kaiser Permanente Research, Pasadena, California.
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.affiliation: Henry Ford Hospital, Detroit, Michigan.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cassidy-Bushrow
authors.affiliation: Kaiser Permanente Northern California, Oakland, California.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Smith
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
authors.forename: Yingjun
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Kaiser Permanente Northern California, Oakland, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Aaronson
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
keywords: androgen antagonists; local; mortality; neoplasm recurrence; prostatic neoplasms; salvage therapy