Evaluation and prediction of therapeutic response to neoadjuvant androgen deprivation therapy for prostate cancer by diffusion weighted imaging / 中华泌尿外科杂志

Objective To evaluate the effect of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer on diffusion weighted imaging base on the pathological results after radical prostatectomy.Methods Medical records of 33 patients diagnosed with prostate cancer and treated with neoadjuvant androgen deprivation therapy and radical prostatectomy between January 2016 and September 2019 at Peking University First Hospital were retrospectively reviewed.Average age of patients was 67.7 (49-81) years old.All of the patients underwent prostate MRI examination before and after neoadjuvant ADT.Results Mean prostate volume after neoadjuvant ADT is 28.5 (6.25-113.76) em3,which decreased significantly by therapy (Z =-4.458,P ＜ 0.05).Apparent diffusion coefficient (ADC) values increased significantly in tumor (1.070 ± 0.325) vs.(0.828 ± 0.291) × 10-3 mm2/s (P ＜ 0.001) and decreased in benign prostatic tissue (P ＜ 0.05).Relative changes in ADC differed significantly between low-median level ISUP group and high level ISUP group (0.315 ± 0.173) vs.(0.164 ± 0.224) × 10-3 mm2/s (P ＜ 0.05),as well as obvious reaction group and focal reaction group(0.278 ± 0.21) vs.(0.094 ± 0.119) × 10-3 mm2/s (P ＜ 0.05).Conclusions There were significant,quantitative measurable changes of ADC value in prostate cancer after neoadjuvant ADT.DWI can be used to assess the efficacy of neoadjuvant ADT for prostate cancer as well as predicting pathological features.

Is neoadjuvant androgen deprivation therapy beneficial in prostate cancer treated with definitive radiotherapy?

PURPOSE: To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique. RESULTS: Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose > or =70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose > or =70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963). CONCLUSION: NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.

Early Experience of Localized Prostate Cancer Treated with Neoadjuvant Androgen Ablation Therapy and Radiotherapy / 대한비뇨기과학회지

PURPOSE: We investigated the trends and results of the outcome in patients with localized and locally advanced prostatic cancer treated with neoadjuvant androgen deprivation (NAAD) and external beam radiotherapy. MATERIALS AND METHODS: 14 patients with localized prostate cancer were treated with a 4 month-scheduled treatment that consisted of NAAD and radiotherapy. The number of patients in the clinical stage T1, T2, T3, and T4 were 3, 5, 2, and 4, respectively. External beam radiotherapy was performed for 6 weeks during NAAD period. After treatment, PSA relapse was evaluated with periodic PSA follow-up. RESULTS: There was no lymph node or distant metastasis in 14 patients. In all cases, PSA was less than 1ng/ml within 3 months of treatment. The number of patients with Gleason scores 2-4, 5-7 and 8-10 were 1, 7, and 4, respectively. In only one case with preradiotherapy PSA nadir level of 0.23ng/ml, the rising PSA level (>2.5ng/ml) was observed at 6 months after the end of the treatment, and the androgen deprivation resumed 10 months after the end of the treatment. No severe complication was observed in all patients, and the observed minor complications were dysuria (3; 21.4%), frequency (2; 14.3%), urgency (1; 7.1%), urethral stricture (1; 7.1%), proctitis (2; 14.3%) and gastrointestinal discomfort (1; 7.1%). CONCLUSIONS: In patients treated with NAAD and radiation therapy for localized or locally confined prostate carcinoma, generally good responses were observed. No se vere complication was observed and more patients and follow up are required for the further conclusion.