Early Androgen Deprivation Beneficial

ROCHESTER, NY—Starting anti-androgen therapy immediately after radical prostatectomy, rather than delaying such treatment until disease progression, improves outcomes in prostate cancer patients found to be node positive after radical prostatectomy and pelvic lymphadenopathy, according to results of an ECOG trial.

The study, headed by Edward M. Messing, MD, of the University of Rochester Medical Center, randomized 100 patients to receive either immediate antiandrogen therapy with goserelin (Zoladex), an LHRH agonist (33 patients) or bilateral orchiectomy (13 patients), or to be followed until disease progression. Most patients (91) had stage T2 disease; 7 had stage T1b disease. Two were found to be ineligible.

With a median follow-up of 7.1 years, survival was significantly better in the immediate-treatment group (P = .02): 18 patients in the observation group had died, 16 of their prostate cancer, vs 7 patients in the immediate-therapy group, 3 of whom died of their prostate cancer (N Engl J Med 341:1781-1788, 1999).

Recurrence-free survival was also significantly better in the immediate-therapy group (P < .001). At the time of last follow-up, 22 observation patients (43%) were alive with no evidence of disease vs 36 immediate-therapy patients (77%).

“It is unlikely that it will be feasible to repeat our study,” Dr. Messing said in the report. “Were it to be carried out today, there would be fewer eligible men because widespread use of serum PSA testing has led to earlier diagnosis of prostate cancer.” Dr. Messing noted that the availability of molecular techniques for identifying nodal micrometastases “may well increase the relevance of early anti-androgen therapy.”