Risk of prostate cancer death after radical radiotherapy with neoadjuvant and adjuvant therapy with bicalutamide or gonadotropin-releasing hormone agonists

Authors

  • Tiago M. Bonde a Department of Urology, Ryhov Hospital, Jönköping, Sweden
  • Hans Garmo b Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  • Pär Stattin b Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  • Per Nilsson c Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
  • Adalsteinn Gunnlaugsson c Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
  • Daniela Swanberg d Department of Surgery, Höglandssjukhuset, Eksjö, Sweden
  • David Robinson e Department of Urology, Höglandssjukhuset, Eksjö, Sweden

DOI:

https://doi.org/10.1080/0284186X.2023.2269600

Keywords:

Prostate neoplasms, androgen antagonists, gonadotropin-releasing hormone, radiotherapy, prognosis, mortality

Abstract

Background

Oncological outcome after radical radiotherapy (RRT) combined with neoadjuvant and adjuvant androgen suppression therapy (AST) may differ according to type of AST. The aim of this nationwide register-based study was to investigate risk of prostate cancer (Pca) death after different neoadjuvant and adjuvant ASTs; (i) bicalutamide, (ii) gonadotropin-releasing hormone agonists (GnRH) or (iii) combined bicalutamide and GnRH (CAB), together with RRT.

Materials and Methods

Data for 6882 men diagnosed with high-risk Pca between 2007 and 2020 and treated with primary RRT was retrieved from Prostate Cancer data Base Sweden (PCBaSe) 5.0. Time to Pca death according to type of neoadjuvant and adjuvant AST was assessed by use of Kaplan–Meier plots and Cox proportional hazard models adjusted for putative confounders.

Results

Data were stratified by RRT type since the effect of AST in risk of Pca death differed according to type of RRT. Compared with the reference RRT combined with neoadjuvant CAB/adjuvant GnRH, risk of Pca death for men treated with CAB/bicalutamide and conventionally fractionated external beam radiotherapy (CF-EBRT) was hazard ratio (HR) 0.73 (95% CI: 0.50–1.04), hypofractionated EBRT (HF-EBRT), HR 1.35 (95% CI: 0.65–2.81) and EBRT with high dose rate brachytherapy (EBRT-HDRBT), HR 0.85 (95% CI: 0.37–1.95). Risk of Pca death for men treated with bicalutamide/bicalutamide and: (i) CF-EBRT was HR 2.35 (95% CI: 1.42–3.90), (ii) HF-EBRT, HR 0.70 (95% CI: 0.26–1.85), (iii) HF-EBRT, HR 4.07 (95% CI: 1.88–8.77) vs the reference.

Conclusion

In this observational study, risk of Pca death between men receiving different combinations of AST varied according to RRT type. No difference was found in risk of Pca death for men treated with bicalutamide or GnRH as adjuvant therapy to RRT following neoadjuvant CAB. Risk of Pca death was increased for men with monotherapy neo-/adjuvant bicalutamide in combination with CF-EBRT or EBRT-HDRBT.

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Additional Files

Published

2023-12-02

How to Cite

Bonde, T. M., Garmo, H., Stattin, P., Nilsson, P., Gunnlaugsson, A., Swanberg, D., & Robinson, D. (2023). Risk of prostate cancer death after radical radiotherapy with neoadjuvant and adjuvant therapy with bicalutamide or gonadotropin-releasing hormone agonists. Acta Oncologica, 62(12), 1815–1821. https://doi.org/10.1080/0284186X.2023.2269600

Issue

Vol. 62 No. 12 (2023): Acta Oncologica

Section

Articles