ROCHESTER, NYStarting 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.