Neoadjuvant Hormonal Therapy Versus Radiotherapy Alone in Treatment of Locally Advanced Prostate Cancer,MAHER EDAROS, NASHWA NAWAR, MOHAMMED A. BADAWY, AHMED M. ELIWA, HAZEM ELGALALY and SALEM KHALIL
Abstract
Introduction: Despite adequate local therapy for carcinoma of the prostate, significant proportion of patients developed a progressive or metastatic disease. Neoadjuvant hormonal therapy not only provides possible early systemic treatment for a subclinical disease, but may also help in improving local disease control by increasing the number of patients eligible for definitive local therapy (via down staging).
Objective: To compare neoadjuvant hormonal therapy before definitive radiotherapy and radiotherapy alone in treatment of locally advanced prostate cancer.
Patients and Methods: We retrospectively compared the oncologic outcome of neoadjuvant hormonal therapy before radical radiotherapy versus radical radiotherapy alone in patients with locally advanced prostatic cancer (T3-T4, Nx, M0) treated between June 2004 and September 2007. Thirty seven patients were included in the study as two groups; group I included 19 patients treated with neoadjuvant hormonal therapy before and during radical radiotherapy (LHRH ana-logue for four months with added flutamide in the 1st month), and group II included 18 patients treated by radical radiotherapy alone. The dose of radiation therapy was 70G (44G to the whole pelvis and 26 G to the prostate and seminal vesicle). Patients were followed for a minimum of 5 years. Follow-up included serum PSA, and TRUS performed three months after therapy. Five-year survival and biochemical-disease-free survival were calculated foe both treatment groups.
Results: The mean patient age was (71.3 y) and (69.7 y) for group I and II respectively. Mean pretreatment PSA was 37.1 ng/ml in group, I and 39.5 ng/ml in group II. Twenty six patients (70.2%) were T3 [group, I (12 patients) and group II (14 patients)] while 11 patients (29.8%) were T4 [group, I (6 patients) and group II (5 patients)]. The Mean follow-up was 61.5 months in group, I and 68 months in group II. There was significant reduction in prostate volume in group, I with a reduction ratio of 25.5% while in group II volume reduction was insignificant. Eleven patients (29.73%) died due to tumor progression, four (10.81%) in group I and seven (18.91%) in group II. Five-year survival rate was 80% in group, I compared to 52.5% in group II. Additionally 5-years biochemical diseasefree survival was 79% in group, I compared to 57% in group II. The time to PSA nadir was earlier in group, I compared to group II (11.2Vs 19.2 months).
Conclusion: Neoadjuvant hormonal therapy combined with radiotherapy showed benefits in terms of 5-year overall survival, biochemical disease-free survival and time to PSA nadir compared to radiotherapy alone. Prospective randomized trial is needed to recommend optimal course, dose and patient selection criteria.