IS PRIMARY HORMONE THERAPY EFFICIENT FOR CLINICALLY LOCALIZED PROSTATE CANCER IN JAPANESE MEN

INTRODUCTION AND OBJECTIVES: To evaluate the efficacy of primary hormone therapy for clinically localized prostate cancer treated with hormone therapy or prostatectomy. METHODS: Among 312 consecutive patients of the Iwakuni Clinical Center with untreated T1c-2N0M0 prostate cancer between 1998 and 2005, 36 cases of radiation therapy or watchful waiting were excluded, and a total of 276 cases were retrospectively reviewed. A total of 135 cases were treated with radical prostatectomy monotherapy, and the other 141 cases, who for various reasons did not have a prostatectomy, were treated with hormone therapy. Of these 118 cases underwent androgen deprivation therapy (ADT) and 23 cases of bicalutamide monotherapy. The median age and median pretreatment PSA level of all the patients were 73 years old and 10.5ng/ml, respectively. The number of patients in low, intermediate and high risk groups were 94, 87 and 93 cases, respectively. RESULTS: The median follow-up time was 5.0 years (range =0.2-10.0 years). The median ages of the hormone therapy group and the surgery group were 77 and 69 years old, respectively. The median pretreatment PSA levels of these two groups were 12.4 and 9.1ng/ml, respectively. There were significant differences in both age and PSA levels. The progression-free survival rates in the hormone group at 5 and 8 years were 60.9% and 57.7%, vs 59.3% and 51.1% in the surgical group (p=0.039). Multivariate proportional hazard analysis revealed that there were significant risk factors in the hormone group (HR 0.414, p=0.001), in low and intermediate risk group and in pretreatment PSA level of less than 10.5 ng/ml. There was no cases of cancer death in these two groups. However, 19 cases in the hormone group died from other causes. There were also no cases of death among patients undergoing bicalutamide monotherapy. The overall survival rates in the hormone group at 5 and 8 years were 90.5% and 72.8%, vs 98.2% and 92.2% in the surgical group (p=0.002). Multivariate proportional hazard analysis revealed that the hormone group (HR 3.192, p=0.050) had the only significant risk factor. An age over 73 years old was not significant. CONCLUSIONS: The results indicated that the risk of death in patients with clinically localized prostate cancer increased in the primary hormone therapy group as compared to the prostatectomy group, despite the usefulness of hormonal therapy in cancer control. We suggest that the increased risk of death in patients receiving hormone therapy is influenced by some complications of avoiding surgery and by some adverse effects of ADT.