OBJECTIVE: To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in (125)I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy. METHODS: A total of 165 patients with T1c-T3b prostate cancer received transperineal ultrasound-guided (125)I permanent seed implantation and neo-adjuvant hormonal therapy (NHT). Their median age was 79 years (range: 65 - 88). They were randomized into 2 groups: group A (n = 90, 3-month NHT before (125)I permanent seed implantation for prostate cancer 0 and group B (n = 75, (125)I permanent seed implantation). The prostate surface antigen (PSA) response rate, the change of prostate volume and the toxicities of urinary system and sexual function were observed. RESULTS: The median PSA decreased to 0.38 (0.01 - 6.56) µg/L from 26.50 (3.56 - 150.00) µg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29.33 (23.62 - 65.21) ml from 46.38 (19.28 - 128.10) ml during a follow-up period of 24 months. After brachytherapy, the PSA level was maintained at a relatively low level (median number of 0.62 µg/L and 2.56 µg/L in groups A and B respectively). And 6 and 9 patients suffered from acute urinary retention after brachytherapy in groups A and B respectively. CONCLUSION:Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time. The toxicities of urinary system, gastrointestinal tract and sexual function should be examined by further randomized control studies. A long-term observation is needed for the PSA-free survival rate.
RCT Entities:
OBJECTIVE: To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in (125)I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy. METHODS: A total of 165 patients with T1c-T3b prostate cancer received transperineal ultrasound-guided (125)I permanent seed implantation and neo-adjuvant hormonal therapy (NHT). Their median age was 79 years (range: 65 - 88). They were randomized into 2 groups: group A (n = 90, 3-month NHT before (125)I permanent seed implantation for prostate cancer 0 and group B (n = 75, (125)I permanent seed implantation). The prostate surface antigen (PSA) response rate, the change of prostate volume and the toxicities of urinary system and sexual function were observed. RESULTS: The median PSA decreased to 0.38 (0.01 - 6.56) µg/L from 26.50 (3.56 - 150.00) µg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29.33 (23.62 - 65.21) ml from 46.38 (19.28 - 128.10) ml during a follow-up period of 24 months. After brachytherapy, the PSA level was maintained at a relatively low level (median number of 0.62 µg/L and 2.56 µg/L in groups A and B respectively). And 6 and 9 patients suffered from acute urinary retention after brachytherapy in groups A and B respectively. CONCLUSION: Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time. The toxicities of urinary system, gastrointestinal tract and sexual function should be examined by further randomized control studies. A long-term observation is needed for the PSA-free survival rate.
Authors: William C Jackson; Holly E Hartman; Robert T Dess; Sam R Birer; Payal D Soni; Jason W D Hearn; Zachary R Reichert; Amar U Kishan; Brandon A Mahal; Zachary S Zumsteg; Jason A Efstathiou; Samuel Kaffenberger; Todd M Morgan; Rohit Mehra; Timothy N Showalter; Daniel A Krauss; Paul L Nguyen; Matthew J Schipper; Felix Y Feng; Howard M Sandler; Peter J Hoskin; Mack Roach; Daniel E Spratt Journal: J Clin Oncol Date: 2020-05-12 Impact factor: 44.544