Overall survival of high-risk prostate cancer patients who received neoadjuvant chemohormonal therapy followed by radical prostatectomy at a single institution.
BACKGROUND
The optimal treatment for high-risk prostate cancer (PCa) remains to be established. We previously reported favorable, biochemical recurrence-free survival in high-risk PCa patients treated with a neoadjuvant gonadotropin-releasing hormone agonist or antagonist and estramustine phosphate (EMP) (chemohormonal therapy; CHT) followed by radical prostatectomy (RP). We conducted a retrospective study to elucidate the clinical benefit of neoadjuvant CHT for high-risk PCa patients.


METHODS
We reviewed the clinical and pathological records of 1254 PCa patients who underwent RP and bilateral pelvic lymphadenectomy between July 1996 and April 2016 at Hirosaki University. According to the D'Amico risk classification, we focused on 613 patients in the high-risk group. The high-risk PCa patients were further divided into two groups based on whether the patients received neoadjuvant CHT before RP (EMP group) or not (non-EMP group). The endpoint was overall survival (OS) after surgery.


RESULTS
The 5- and 10-year OS rates were 98.5 and 92.6%, respectively. The 10-year OS rate in the EMP group was significantly higher compared to the non-EMP group (P = 0.021). In multivariate analysis, administration of neoadjuvant CHT, lymph node involvement, and castration-resistant PCa status were significantly associated with OS.


CONCLUSIONS
RP with neoadjuvant CHT using EMP for high-risk PCa patients provided excellent long-term OS.
['Fujita|Naoki|N|', 'Koie|Takuya|T|', 'Ohyama|Chikara|C|', 'Tanaka|Yoshimi|Y|', 'Soma|Osamu|O|', 'Matsumoto|Teppei|T|', 'Yamamoto|Hayato|H|', 'Imai|Atsushi|A|', 'Tobisawa|Yuki|Y|', 'Yoneyama|Tohru|T|', 'Hatakeyama|Shingo|S|', 'Hashimoto|Yasuhiro|Y|']
D000368:Aged D018931:Antineoplastic Agents, Hormonal D000971:Antineoplastic Combined Chemotherapy Protocols D004961:Estramustine D007987:Gonadotropin-Releasing Hormone D017273:Goserelin D006801:Humans D016729:Leuprolide D008197:Lymph Node Excision D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D020360:Neoadjuvant Therapy D011468:Prostatectomy D011471:Prostatic Neoplasms D012189:Retrospective Studies D015996:Survival Rate
Overall survival Prostate cancer Neoadjuvant chemohormonal therapy Radical prostatectomy Estramustine phosphate