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Phase II Study of Neoadjuvant Androgen Deprivation Followed by External-Beam Radiotherapy With 9 Months of Androgen Deprivation for Intermediate- to High-Risk Localized Prostate Cancer

Jonas J. Heymann, Mitchell C. Benson, Kathleen M. O'Toole, Bozena Malyszko, Rachel Brody, Darleen Vecchio, Peter B. Schiff, Mahesh M. Mansukhani, Ronald D. Ennis

From the Columbia University Medical Center, New York, NY

Address reprint requests to Ronald D. Ennis, MD, St Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, Lower Level, New York, NY 10019; e-mail: rennis{at}chpnet.org

Purpose: To evaluate the toxicity and efficacy of individualized neoadjuvant androgen deprivation (AD) to maximal response followed by external beam radiotherapy (RT) with continued AD for a total of 9 months in a prospective phase II trial.

Patients and Methods: One hundred twenty-three patients received a total of 9 months of flutamide and luprolide combined with RT. RT initiation was individualized to begin after maximum response to AD as assessed by monthly digital rectal examination and prostate-specific antigen (PSA). The neoadjuvant phase was restricted to no more than 6 months.

Results: Median time to initiation of RT was 4.7 months. Indications to begin RT (and their rates) were undetectable PSA (28%), PSA unchanged from one month to the next (46%), PSA rising from one month to the next (10%), 6 months of AD (14%), and other (2%). Five-year outcomes were biochemical disease-free survival, (DFS) 63% ± 7%; clinical DFS, 75% ± 5%; cancer-specific survival, 99% ± 1%; and overall survival, 89% ± 3%. Patients initiating RT after 6 months of AD had significantly lower biochemical and clinical DFS. Those patients whose testosterone recovered to normal after completion of AD had a significantly superior survival rate. Of those patients potent before treatment, 65% remained so at last follow-up.

Conclusion: The combination of 9 months of AD and RT, with initiation of RT individualized on the basis of maximum response to AD, achieves disease control rates comparable with past studies, while preserving potency in many patients. Further studies are warranted to determine the optimal combination of AD and RT in this patient population.

Supported by an unrestricted educational grant from Integrated Therapeutics Group Inc, a subsidiary of Schering-Plough, and by TAP Pharmaceuticals.

Presented in part at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology, November 4-8, 2001, San Francisco, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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