Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Risk Factors for Clinical Metastasis in Men Undergoing Radical Prostatectomy and Immediate Adjuvant Androgen Deprivation Therapy

  • Taguchi, Satoru (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Fukuhara, Hiroshi (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Kakutani, Shigenori (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Takeshima, Yuta (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Miyazaki, Hideyo (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Suzuki, Motofumi (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Fujimura, Tetsuya (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Nakagawa, Tohru (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Igawa, Yasuhiko (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Kume, Haruki (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Homma, Yukio (Department of Urology, Graduate School of Medicine, The University of Tokyo)
  • Published : 2015.01.22
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Abstract

Background: Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Materials and Methods: We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP. Results: Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ${\geq}9$ and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ${\geq}9$ was an independent predictor of cancer-specific death. Conclusions: Pathologic GS ${\geq}9$ and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ${\geq}9$ was an indispensable condition for bone metastasis, which may imply that patients with GS ${\leq}8$ on adjuvant ADT are unlikely to develop bone metastasis.

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References

  1. Abdollah F, Karnes RJ, Suardi N, et al (2014). Predicting survival of patients with node-positive prostate cancer following multimodal treatment. Eur Urol, 65, 554-62. https://doi.org/10.1016/j.eururo.2013.09.025
  2. Akaza H, Cheng JC, Chung BH, et al (2013). NCCN clinical practice guidelines in oncology (NCCN $Guidelines^{(R)}$)-asia consensus statement: prostate cancer version 2.2013. http://www.nccn.org/international/PDF/prostate-asia.pdf.
  3. Carver BS, Bianco FJ Jr, Scardino PT, Eastham JA (2006). Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. J Urol, 176, 564-8. https://doi.org/10.1016/j.juro.2006.03.093
  4. D'Amico AV, Whittington R, Malkowicz SB, et al (1998). Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA, 280, 969-74. https://doi.org/10.1001/jama.280.11.969
  5. Dorff TB, Flaig TW, Tangen CM, et al (2011). Adjuvant androgen deprivation for high-risk prostate cancer after radical prostatectomy: SWOG S9921 study. J Clin Oncol, 29, 2040-5. https://doi.org/10.1200/JCO.2010.32.2776
  6. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: Intl Agency Res Cancer. Available from: http://globocan.iarc.fr, accessed on day/month/year.
  7. Jackson W, Hamstra DA, Johnson S, et al (2013). Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer, 119, 3287-94. https://doi.org/10.1002/cncr.28215
  8. Matsuda A, Matsuda T, Shibata A, et al (2014). The Japan cancer surveillance research group. cancer incidence and incidence rates in Japan in 2008: a study of 25 population-based cancer registries for the monitoring of cancer incidence in Japan (MCIJ) Project. Jpn J Clin Oncol, [E-pub ahead of print].
  9. McGrowder DA, Jackson LA, Crawford TV (2012). Prostate cancer and metabolic syndrome: is there a link? Asian Pac J Cancer Prev, 13, 1-13. https://doi.org/10.7314/APJCP.2012.13.1.001
  10. Messing EM, Manola J, Sarosdy M, et al (1999). Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med, 341, 1781-8. https://doi.org/10.1056/NEJM199912093412401
  11. Messing EM, Manola J, Yao J, et al (2006). Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol, 7, 472-9. https://doi.org/10.1016/S1470-2045(06)70700-8
  12. Mohler J, Bahnson RR, Boston B, et al (2010). NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw, 8, 162-200.
  13. Nguyen CT, Reuther AM, Stephenson AJ, Klein EA, Jones JS (2009). The specific definition of high risk prostate cancer has minimal impact on biochemical relapse-free survival. J Urol, 181, 75-80.
  14. Petrovich Z, Lieskovsky G, Stein JP, Huberman M, Skinner DG (2002). Comparison of surgery alone with surgery and adjuvant radiotherapy for pT3N0 prostate cancer. BJU Int, 89, 604-11. https://doi.org/10.1046/j.1464-410X.2002.02698.x
  15. Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ (2004). Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: Long-term results. J Urol, 172, 910-4. https://doi.org/10.1097/01.ju.0000134888.22332.bb
  16. Ryan CJ, Small EJ (2005). Early versus delayed androgen deprivation for prostate cancer: new fuel for an old debate. J Clin Oncol, 23, 8225-31. https://doi.org/10.1200/JCO.2005.03.5311
  17. Sato YT, Fukuhara H, Suzuki M, et al (2014). Long-term results of radical prostatectomy with immediate adjuvant androgen deprivation therapy for pT3N0 prostate cancer. BMC Urol, 14, 13. https://doi.org/10.1186/1471-2490-14-13
  18. Situmorang GR, Umbas R, Mochtar CA, et al (2012). Prostate cancer in younger and older patients: do we treat them differently? Asian Pac J Cancer Prev, 13, 4577-80. https://doi.org/10.7314/APJCP.2012.13.9.4577
  19. Sundi D, Wang VM, Pierorazio PM, et al (2014). Very-high-risk localized prostate cancer: definition and outcomes. Prostate Cancer Prostatic Dis, 17, 57-63. https://doi.org/10.1038/pcan.2013.46
  20. Taguchi S, Fujimura T, Kume H, Homma Y (2012). Zoledronic acid administration in aggressive castration-resistant prostate cancer. Asian Pac J Cancer Prev, 13, 6539-40. https://doi.org/10.7314/APJCP.2012.13.12.6539