Originally published as JCO Early Release 10.1200/JCO.2007.14.2042 on December 1 2008

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Role of Androgen Deprivation Therapy for Node-Positive Prostate Cancer

Yu-Ning Wong, Stephen Freedland, Brian Egleston, Gary Hudes, J. Sanford Schwartz, Katrina Armstrong

From the Divisions of Population Science and Medical Science; Division of Medical Science; and Biostatistics Facility, Fox Chase Cancer Center; Division of General Internal Medicine, Abramson Cancer Center; and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; and Department of Urology, Duke University School of Medicine, Durham, NC

Corresponding author: Yu-Ning Wong, MD, MSCE, Divisions of Population Science and Medical Science, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail: Y_Wong{at}fccc.edu

Purpose To determine the impact of adjuvant androgen deprivation therapy (ADT) for patients who have node-positive prostate cancer in the prostate-specific antigen (PSA) era.

Patients and Methods We used linked Surveillance, Epidemiology and End Results-Medicare data to construct a cohort of men who underwent radical prostatectomy (RP) between 1991 and 1999 and who had positive regional lymph nodes. We classified men as receiving adjuvant ADT if they received ADT within 120 days of RP, and we compared them to the men who had not received adjuvant ADT. We used propensity scores to balance potential confounders of receiving adjuvant ADT (ie, tumor characteristics, extent of nodal disease, demographics, receipt of radiation therapy) and Cox proportional hazard methods to measure the impact of adjuvant ADT on overall survival (OS), stratified by propensity score quintile. We conducted a sensitivity analysis that used 90, 150, 180, and 365 days as the definition for adjuvant ADT.

Results A total of 731 men were identified, 209 of whom received ADT within 120 days of RP. There was no statistically significant difference in OS between the adjuvant ADT and non-ADT group (HR, 0.97; 95% CI, 0.71 to 1.27). There was no statistically significant survival difference with 90, 150, 180, and 365 days as the adjuvant ADT definition.

Conclusion Deferring immediate ADT in men with positive lymph nodes after RP may not significantly compromise survival. Because observational studies should be considered hypothesis-generating studies, these results should be validated in a prospective fashion in a similar patient population.

published online ahead of print at www.jco.org on December 1, 2008.

Supported by Grants No. P50-CA105461 and P30-CA006927 from the Center for Population Health and Health Disparities at the University of Pennsylvania, Public Health Services, Comprehensive Cancer Center Program at Fox Chase.

Presented in part at the Prostate Cancer Symposium, February 22-24, 2007, Orlando, FL and at the 43rd Annual meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

This study used the linked Surveillance, Epidemiology, and End Results–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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This article has been cited by other articles:

				S. Culine Androgen Deprivation Therapy for Node-Positive Prostate Cancer: Adjuvant Does Not Mean Salvage J. Clin. Oncol., June 10, 2009; 27(17): 2888 - 2888. [Full Text] [PDF]

				Y.-N. Wong and K. Armstrong Reply to S. Culine J. Clin. Oncol., June 10, 2009; 27(17): 2888 - 2888. [Full Text] [PDF]