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Multi-modal therapy for prostate cancer: long-term outcomes of neoadjuvant androgen deprivation therapy, prostatectomy, and post-operative radiotherapy.
Drew A. Palmer, MD, John A. Libertino, MD.
Lahey Hospital & Medical Center, Burlington, MA, USA.

BACKGROUND:
In the era of risk stratification of prostate cancer patients, there is still considerable debate surrounding the treatment of high-risk disease. Patients with high-risk prostate cancer are at significant risk of recurrence and the optimal treatment regimen is unclear. Multi-modal treatment protocols including androgen deprivation therapy (ADT), surgery, and radiotherapy offer potential benefit in patients who have an increased risk of recurrence. Our objective was to present the long-term outcomes of a multi-modal treatment regimen consisting of neoadjuvant ADT, prostatectomy, and post-operative radiotherapy for patients with prostate cancer who have an increased risk of recurrence.
METHODS:
A retrospective review was performed on a prospectively maintained database of 4955 patients with prostate cancer who underwent prostatectomy at a tertiary care hospital between 1983 and 2013. We identified 70 patients who received neoadjuvant ADT, prostatectomy, and either adjuvant or salvage radiotherapy. All patients underwent either radical retropubic or radical perineal prostatectomy. Patient demographics, hormone regimen, surgical approach, pathologic features, radiotherapy modality and outcomes were identified.
RESULTS:
Mean age was 60.9 years (IQR, 56-66 years). The mean follow up was 92 months (IQR, 45-142 months). The majority of patients had Gleason 8, 9, and 10 disease (57.1%), followed by Gleason 7 (33.3%) and Gleason 6 (9.5%). Most patients demonstrated T3 disease on pathology (67.6%), followed by T2 (25.0%) and T4 (7.4%) disease. 50% of the patients had positive margins on pathology. The post-operative radiation regimen consisted of adjuvant treatment for 46 patients (65.7%) and salvage treatment for 23 patients (32.9%). 31 patients (44.3%) were free from biochemical recurrence at the most recent follow up. The disease specific and overall survivals were 83% and 67% in this cohort, respectively.
CONCLUSIONS:
Multi-modal treatment regimens offer a potential benefit for patients at increased risk of recurrence due to high-risk disease or positive surgical margins. Continued investigation into the role of neoadjuvant ADT and post-operative radiation therapy for patients with aggressive disease is needed.


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