Risks of Progression After Early Androgen Deprivation Therapy for Biochemical Recurrence After Radical Prostatectomy

Area of Science:

• Urology
• Oncology
• Prostate Cancer Research

Background:

• Prognostic models for prostate cancer recurrence often use outdated data.
• Current treatment involves early androgen deprivation therapy (ADT) before metastasis.
• Updated prognostic data is needed for men receiving early ADT post-prostatectomy.

Purpose of the Study:

• To define cancer progression and mortality rates in men receiving early ADT for biochemical recurrence (BCR) after radical prostatectomy (RP).
• To provide contemporary prognostic estimates for men with BCR post-RP treated with early ADT.

Main Methods:

• Observational study of 1108 men with nonmetastatic prostate cancer receiving ADT for BCR post-RP (1988-2019).
• Utilized Fine and Gray competing risk models to assess risks of metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM).
• Key predictors analyzed included pre-ADT PSA, PSA doubling time, pathologic grade group, and seminal vesicle invasion.

Main Results:

• At 15 years post-ADT, risks were: metastasis (28%), CRPC (27%), and PCSM (19%).
• Higher pre-ADT PSA, shorter PSA doubling time, higher grade group, and seminal vesicle invasion predicted increased risk.
• Predictive nomograms and tables were developed for 3-, 5-, 10-, and 15-year risks.

Conclusions:

• Contemporary prognostic estimates are more relevant for men receiving early ADT for post-RP BCR.
• These estimates can aid in identifying high-risk patients.
• Identified patients may be candidates for intensified hormonal therapy.