Duration of neoadjuvant androgen deprivation therapy before radical prostatectomy and disease-free survival in men with prostate cancer

There is little evidence that neoadjuvant androgen deprivation therapy (ADT ) of 3 months' duration before radical prostatectomy (RID) favorably influe nces disease-free survival. However, recent data suggest that prolonged tre atment may improve outcome. We conducted a prospective cohort study to dete rmine whether ADT of either standard or prolonged duration before RIP influ ences the risk of prostate-specific antigen (PSA) failure. We followed 756 men treated for prostate cancer by RP between 1991 and 1998 in Quebec City. Of these, 240 received combined neoadjuvant ADT for either < 92 days (129 men) or less than or equal to 92 days (129 men), and 516 were treated by RI D alone. Multivariate Cox regression was used to estimate the hazard ratios (HR) of PSA failure (> 0.3 ng/mL) associated with treatment regimen contro lling for age, clinical stage, grade, and initial PSA level. The median dur ation of follow-up was 4 years. Compared with men treated by RP alone, thos e who received neoadjuvant ADT for greater than or equal to 93 days had an HR of PSA failure of 0.60. The inverse association with the risk of PSA fai lure became statistically significant from the third year on, reached its g reatest magnitude after 4 years, and was still present 8 years after RID. N o association was observed for ADT of : 92 days. These results suggest that neoadjuvant ADT before RID has a real, delayed, and persistent effect on d isease-free survival, if and only if ADT is prolonged beyond 3 months. (C) 2001, Elsevier Science Inc.