Favorable prognosis of patients who received adjuvant androgen deprivation therapy after radiotherapy achieving undetectable levels of prostate-specific antigen in high- or very high-risk prostate cancer

• Published in: PloS one Vol. 16; no. 3; p. e0248461
• Main Authors: Jeong, Jae-Uk, Nam, Taek-Keun, Song, Ju-Young, Yoon, Mee Sun, Ahn, Sung-Ja, Chung, Woong-Ki, Cho, Ick Joon, Kim, Yong-Hyub, Cho, Shin Haeng, Jung, Seung Il, Kang, Taek Won, Kwon, Dong Deuk
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12-03-2021; Public Library of Science (PLoS)
• Subjects: Androgen suppression therapy; Biology and Life Sciences; Care and treatment; Evaluation; Medicine and Health Sciences; Methods; Patient outcomes; Prognosis; Prostate cancer; Radiotherapy; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248461

To determine the prognostic significance of long-term adjuvant androgen deprivation therapy (A-ADT) over 1 year in achieving undetectable levels of prostate-specific antigen (PSA) less than 0.001 ng/mL in prostate cancer patients with high- or very high-risk prostate cancer who underwent radiotherapy (RT).
A total of 197 patients with prostate cancer received RT, with a follow-up of ≥12 months. Biochemical failure was defined as PSA ≥nadir + 2 ng/mL after RT. We analyzed clinical outcomes, including survival, failure patterns, and prognostic factors affecting outcomes.
Biochemical failure-free survival (BCFFS), clinical failure-free survival, distant metastasis-free survival, cancer-specific survival, and overall survival (OS) rates at 5 years were 91.1%, 95.4%, 96.9%, 99.5%, and 89.1%, respectively. Administration of long-term A-ADT significantly predicted favorable BCFFS (p = 0.027) and OS (p < 0.001) in multivariate analysis. Nadir PSA ≤0.001 ng/mL was an independent prognostic factor for BCFFS (p = 0.006) and OS (p = 0.021). The use of long-term A-ADT significantly affected nadir PSA ≤0.001 ng/mL (p < 0.001). The patients with A-ADT for 1 year or longer had better BCFFS or OS than those for less than 1 year or those without A-ADT (p < 0.001). The best prognosis was demonstrated in patients treated with long-term A-ADT and nadir PSA ≤0.001 ng/mL in BCFFS (p < 0.001).
The addition of long-term A-ADT over 1 year to RT demonstrated good treatment outcomes in patients with locally advanced prostate cancer. Achieving a nadir PSA value ≤0.001 ng/mL using combination therapy with RT and A-ADT is a powerful clinical predictor of treatment outcomes.