Impact of Early Salvage Androgen Deprivation Therapy in Localized Prostate Cancer after Radical Prostatectomy: A Propensity Score Matched Analysis
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Purpose: Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) ofprostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remainscontroversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specificantigen (PSA) values met the clinical definition of BCR. Materials and Methods: We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients wereassigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definitionof BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed. Results: The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analysesshowed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but didnot have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the nonorganconfined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however,did not correlate with CSS (p=0.107). Conclusion: Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in nonorganconfined PCa.
Abstract
Purpose: Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) ofprostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remainscontroversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specificantigen (PSA) values met the clinical definition of BCR. Materials and Methods: We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients wereassigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definitionof BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed. Results: The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analysesshowed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but didnot have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the nonorganconfined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however,did not correlate with CSS (p=0.107). Conclusion: Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in nonorganconfined PCa.
참고문헌 (21)
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