Purpose: To examine the value of androgen deprivation (AD) in the curative treatment of low- and intermediate-risk prostate cancer treated with the three major modalities: radical retropubic prostatectomy (RRP), external beam radiotherapy (EBRT), and permanent prostate implantation (PI).
Methods and materials: During 1996-2001, 1668 patients with low- and intermediate-risk prostate cancer were treated at The Cleveland Clinic Foundation. Only patients with a minimum of 2 years of prostate-specific antigen follow-up were included in the analysis, and biochemical relapse-free survival (bRFS) was used as the endpoint. Patients were grouped according to treatment modality and stratified according to the use of AD.
Results: The overall 5-year bRFS rate was 87.8%. The 5-year bRFS rate for low-risk patients was 89% and for intermediate-risk patients was 79%. For low-risk patients, the 5-year bRFS rates by treatment modality (without AD vs. with AD, respectively) were PI: 90% vs. 93%; EBRT: 90% vs. 93%; and RRP: 89% vs. 84%. For intermediate-risk patients, the 5-year bRFS rates by treatment modality (without AD vs. with AD, respectively) were PI: 88% vs. 82%; EBRT: 81% vs. 84%; and RRP: 75% vs. 72%. None of the comparisons within risk groups or among modalities supports an increased efficacy with the use of AD.
Conclusion: Five-year bRFS rates in low-risk and intermediate-risk patients are not improved by the use of AD.