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Adjuvant therapy for localized prostate cancer

J D Schmidt1, R P Gibbons, G P Murphy

  • 1Division of Urology, UCSD Medical Center 92103-8897.

Cancer
|February 1, 1993
PubMed
Summary
This summary is machine-generated.

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Adjuvant estramustine phosphate improved progression-free survival in prostate cancer patients with pelvic node involvement after irradiation. This therapy showed significant benefits compared to cyclophosphamide or observation alone.

Area of Science:

  • Oncology
  • Urology
  • Clinical Trials

Background:

  • The National Prostatic Cancer Project initiated trials in 1978 to assess adjuvant therapies for localized prostate cancer post-surgery or irradiation.
  • All participants underwent staging pelvic lymphadenectomy.

Purpose of the Study:

  • To evaluate the efficacy of cyclophosphamide versus estramustine phosphate as adjuvant therapy compared to observation in patients with clinically localized prostate cancer.
  • To analyze outcomes based on treatment protocol (surgery vs. irradiation) and lymph node involvement.

Main Methods:

  • Patients received either cyclophosphamide, estramustine phosphate, or were observed after definitive treatment.
  • Randomization occurred after surgery (Protocol 900) or irradiation (Protocol 1000).

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  • Patient accrual concluded in 1985, with 170 (Protocol 900) and 233 (Protocol 1000) evaluable patients.

    • Main Results:

    • Lymph node involvement was present in 49% of patients, higher in Protocol 1000 (63%) than Protocol 900 (29%).
    • Estramustine phosphate significantly improved median progression-free survival (PFS) in Protocol 1000 patients (48.2 months) compared to cyclophosphamide (35.6 months).
    • In Protocol 1000, estramustine phosphate prolonged PFS for patients with nodal involvement (37.3 months vs. 20.9 months) and extensive nodal disease (32.8 months vs. 12.9 months).

    Conclusions:

    • Adjuvant estramustine phosphate demonstrated a significant benefit for prostate cancer patients with pelvic node involvement treated with irradiation.
    • The findings suggest estramustine phosphate is a valuable option for select prostate cancer patients post-irradiation with nodal metastasis.