Acceptability of short term neo-adjuvant androgen deprivation in patients with locally advanced prostate cancer

Lamb, David S., Denham, James W., Mameghan, Hedy, Joseph, David, Turner, Sandra, Matthews, John, Franklin, Ian, Atkinson, Chris, North, John, Poulsen, Michael, Kovacev, Olga, Robertson, Randall, Francis, Lynne, Christie, David, Spry, Nigel A., Tai, Keen. -H., Wynne, Chris and Duchesne, Gillian (2003) Acceptability of short term neo-adjuvant androgen deprivation in patients with locally advanced prostate cancer. Radiotherapy and Oncology, 68 3: 255-267. doi:10.1016/S0167-8140(03)00193-2

Author Lamb, David S.
Denham, James W.
Mameghan, Hedy
Joseph, David
Turner, Sandra
Matthews, John
Franklin, Ian
Atkinson, Chris
North, John
Poulsen, Michael
Kovacev, Olga
Robertson, Randall
Francis, Lynne
Christie, David
Spry, Nigel A.
Tai, Keen. -H.
Wynne, Chris
Duchesne, Gillian
Title Acceptability of short term neo-adjuvant androgen deprivation in patients with locally advanced prostate cancer
Journal name Radiotherapy and Oncology   Check publisher's open access policy
ISSN 0167-8140
Publication date 2003
Sub-type Article (original research)
DOI 10.1016/S0167-8140(03)00193-2
Volume 68
Issue 3
Start page 255
End page 267
Total pages 13
Place of publication Amsterdam
Publisher Elsevier
Collection year 2003
Language eng
Subject C1
321015 Oncology and Carcinogenesis
730108 Cancer and related disorders
Abstract Purpose: To determine the acceptability of short term neo-adjuvant maximal androgen deprivation (MAD) to patients treated with external beam radiation for locally advanced prostate cancer. Methods: Between 1996 and 2000, 818 patients with locally advanced, but non-metastatic, prostate cancer were entered into a randomised clinical trial (TROG 96.01), which compared radiation treatment alone with the same radiation treatment and 3 or 6 months neo-adjuvant MAD with goserelin and flutamide. Relevant symptoms, and how troublesome they were to the patient, were scored using a self-assessment questionnaire. This was completed by the patient at registration, and at specified times during and after treatment. Patients taking flutamide had liver function tests checked at regular intervals. Results: All patients have completed at least 12 months follow-up after treatment. Nearly all patients completed planned treatment with goserelin, but 27% of patients in the 6-month MAD treatment arm, and 20% in the 3-month arm, had to stop flutamide early. This was mainly due to altered liver function (up to 17% patients) and bowel side effects (up to 8% patients). However, although flutamide resulted in more bowel symptoms for patients on MAD, there was significant reduction in some urinary symptoms on this treatment. Acute bowel and urinary side effects at the end of radiation treatment were similar in all treatment arms. Side effect severity was unrelated to radiation target volume size, which was reduced by MAD, but symptomatology prior to any treatment was a powerful predictor. Of the 36% of patients who were sexually active before any treatment, the majority became inactive whilst on MAD. However, sexual activity at 12 months after radiation treatment was similar in all treatment arms, indicating that the effects of short term MAD on sexual function are reversible. Conclusion: Despite temporary effects on sexual activity, and compliance difficulties with flutamide, short-term neo-adjuvant MAD was not perceived by patients to be a major inconvenience. If neo-adjuvant MAD in the way tested can be demonstrated to lead to improved biochemical control and/or survival, then patients would view these therapeutic gains as worthwhile. Compliance with short-term goserelin was excellent, confirming that LH-RH analogues have a potential role in more long-term adjuvant treatment. However, for more protracted androgen deprivation, survival advantages and deleterious effects need to be assessed in parallel, in order to determine the optimal duration of treatment. (C) 2003 Elsevier Ireland Ltd. All fights reserved.
Keyword Oncology
Radiology, Nuclear Medicine & Medical Imaging
Prostate Cancer
External Beam Radiation Treatment
Neo-adjuvant Androgen Deprivation
Conformal Radiation-therapy
Randomized Trial
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 27 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 32 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 02:40:15 EST