Hormonal therapy efficacy after prostatectomy varies according to patient pathology

The efficacy of long-term hormonal therapy (HT) concomitant with salvage radiation therapy (SRT) in patients who have undergone prostatectomy depends on clinical and pathological characteristics, a recent study has found.

Researchers enrolled 1,264 men who were receiving SRT after radical prostatectomy (RP). Indications for SRT were increasing or persistent prostate-specific antigen (PSA) levels after RP. The primary outcome was clinical recurrence (CR) after SRT, identified through radiologic imaging and confirmed through biopsy.

Majority of the participants (66 percent; n=729; median age at RP, 64 years) did not receive HT concomitant with SRT; 370 did (34 percent; median age, 65 years).

Over a median follow-up of 93 months after surgery, CR was reported in 182 patients. The resulting CR-free survival rate after 8 years was 92 percent. Multivariable Cox regression analysis found that receiving HT was significantly and inversely correlated with the risk of CR (hazard ratio [HR] per 2 months on HT, 0.95, 95 percent CI, 0.92–0.99; p=0.022).

This relationship differed according to the number of risk factors present in the patients. For instance, long-term HT (≤36 months) was effective only in patients with ≥2 risk factors, while those with only one risk factor benefited the most from short regimens of HT, lasting for less than a year.

In patients with no risk factors, HT did not appear to be particularly beneficial, such that the risk of CR remained low and consistent regardless of HT duration. The three risk factors considered were pathologic stage, Gleason score and PSA concentration at RT.