Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy

Purpose: To assess the role of neoadjuvant androgen deprivation (NAAD) and transperineal interstitial permanent prostate brachytherapy (TIPPB) using a matched-pair analysis selected from a large cohort of patients undergoing TIPPB. Patients and Methods: Six hundred twelve consecutive patients with clinical ly confined prostate cancer were treated between June 1992, and January 199 7, with permanent ultrasound-guided TIPPB with either palladium-103 or iodi ne-125 as monotherapy or combined with external radiation. Patients with pr ostate glands greater than or equal to 60 g underwent treatment with NAAD b efore TIPPB to reduce the prostate volume (n = 163). The median duration of NAAD was 3.4 months before TIPPB (range, 1 to 8 months). To assess the ben efit of NAAD, a matched-pair analysis was performed. The American Society o f Therapeutic Radiology and Oncology Consensus Group definition of prostate -specific antigen (PSA) relapse-free survival (RFS) wets used with the adde d caveat of an absolute increase of 1.0 ng/mL. Differences in pretreatment PSA, Gleason scores, and stage were analyzed by Kaplan-Meier curves and the log-rank test. Results: Two hundred sixty-three patients were matched, with a median follo w-up duration of 46 months (range, 24 to 76 months). The actuarial 5-year P SA-RFS rate for all 263 patients is 86.5%. The 5-year PSA-RFS rate for pati ents treated with NAAD and TIPPB wets 87.1% compared with 86.9% for those t reated with TIPPB only (P = .935), Subgroup analysis by Gleason score group ings, pretreatment PSA, or stage of disease failed to identify any factors for which androgen ablation wets beneficial. Conclusion: We were unable to Identify any improvement with the addition of NAAD to TIPPB in patients with localized prostate cancer in this retrospec tive matched-pair analysis. furthermore, there was no subset for which the addition of NAAD was found to be beneficial. Clarification of the role and duration of NAAD in patients with early-stage prostate cancer will require prospective data. (C) 2000 by American Society of Clinical Oncology.