Abstract

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• OBJECTIVE:

  To determine whether men who relapse after neoadjuvant androgen ablation (NAA) and high-dose radiation therapy (RT) have faster PSA doubling times (PSAdt) than those who are treated with RT alone.

  MATERIALS AND METHODS:

  From a prospective database of 1880 patients treated with RT for localized prostate cancer, patients were selected for further study if they had a rising PSA profile >1 ng/ml, and were treated with either no NAA, or prolonged NAA (defined as 3-12 months NAA) with a minimum 5 years follow-up. The PSAdt was calculated from the exponential line of best fit from the first post-nadir value >1 ng/ml to the last PSA prior to secondary intervention. Those patients with a rising PSA profile at 5 years of follow-up were further examined with linear regression to determine factors of possible independent adverse effect.

  RESULTS:

  There were 251 patients eligible with rising PSA profiles. Patients treated with NAA had higher pre-treatment Gleason scores (p<0.001), PSA (p<0.001), and T stage (p<0.001). Median duration of NAA was 5.1 months. Rising PSA profiles occurred in 78% of the RT-only group and 70% of the NAA group. In regression analysis, factors predictive of more rapid PSAdt were pre-treatment Gleason score (p<0.001), pre-treatment PSA (p=0.025), and T stage (p=0.017). The use of NAA (p=0.4) was not significant.

  CONCLUSION:

  The use of prolonged NAA in men treated with RT does not itself cause a more rapid PSAdt when relapse occurs. Faster relapse observed in these men is due to intrinsically more aggressive tumors prior to treatment.