Early Endocrine Therapy Versus Radical Prostatectomy Combined with Early Endocrine Therapy for Stage D1 Prostate Cancer

Objective: To compare disease progression and survival of patients with stage D1 adenocarcinoma after treatment with either early androgen ablation alone or combined with radical prostatectomy.

Patients And Methods: A retrospective non-randomized study was performed in a series of 76 consecutive patients who underwent pelvic lymphadenectomy and had pathological stage D1 (T1-3, pN1-2, MO) prostate cancer; 37 patients underwent early endocrine therapy (EET) and 39 underwent radical prostatectomy with immediate adjuvant endocrine therapy (combined therapy, COM). The median follow-up was 3.8 years (range 0.26-13). The patients were statistically homogeneous for tumour grade, local tumour stage and nodal involvement, but not for age at lymphadenectomy (67 years and 62 years, respectively, P = 0.019, a confounding factor in favour of COM).

Results: Twelve patients (32%) in the EET group and 11 (28%) in the COM group died: the Kaplan-Meier actuarial overall survival curves showed no statistically significant difference between the treatment groups, but there was a trend in favour of the COM group. There was also no significant difference in the cause-specific survival. In the EET group, 17 men (46 %) had local (five of 37, 14%) or systemic (13 of 37, 35%) progression and in the COM group 23 patients (59%) had local (eight of 39, 21%) or systemic (20 of 39, 51%) progression. Four patients had an elevated level of prostate specific antigen with no clinical recurrence. Transurethral resection of the prostate was necessary for three (8%) patients in the EET group and for two (5%) of those receiving COM. The Kaplan-Meier actuarial disease-free survival curves were not significantly different. Similar results were obtained when the 25 patients with early-stage (T1 and T2) and the 51 patients with advanced primary tumours (T3 and T4) were analysed separately.

Conclusion: These results suggest that in patients with stage D1 prostate cancer, radical prostatectomy combined with adjuvant endocrine therapy offers no advantage over endocrine therapy alone, neither for curative nor palliative intent.