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Originally published as JCO Early Release 10.1200/JCO.2009.22.3586 on April 27 2009 © 2009 American Society of Clinical Oncology.
Reply to S. CulineCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania; and Fox Chase Cancer Center, Philadelphia, PA
Center for Clinical Epidemiology and Biostatistics; and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA We appreciate Dr Culine's comments1 and agree that the lack of prostate-specific antigen data and indication for androgen deprivation therapy (ADT) were limitations of our study.2 We also agree with the observation that patients who received ADT shortly after surgery were more likely to have received adjuvant therapy, whereas patients who received ADT later may have received it in the salvage setting. However, we respectfully disagree with Dr Culine's statement that ADT should be initiated within 8 weeks of surgery. In the report by Messing et al,3 adjuvant therapy was shown to have had significant benefit in patients randomly selected to receive it within 12 weeks (3 months) of radical prostatectomy. To address these concerns, we conducted a sensitivity analysis that varied the definition of adjuvant therapy by varying the interval between surgery and initiation of ADT from 90 to 365 days. As described in our report2 under Results, we did not find a statistically significant difference in overall survival using these alternate definitions, which included the 90-day interval used in the Messing et al study.3 Like Dr Culine, we believe that additional study is required to address this important question. We believe that the findings in our observational study2 suggest that in the era of prostate-specific antigen, deferring immediate ADT in patients with node-positive disease may not compromise survival. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Culine S: Androgen deprivation therapy for node-positive prostate cancer: Adjuvant does not mean salvage. J Clin Oncol 27:2888; 2009. 2. Wong YN, Freedland S, Egleston B, et al: Role of androgen deprivation therapy for node-positive prostate cancer. J Clin Oncol 27:100–105, 2009. 3. Messing EM, Manola J, Sarosdy M, et al: Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 341:1781–1788, 1999.
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Copyright © 2009 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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