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Open AccessArticle

Optimal Androgen Deprivation Therapy Combined with Proton Beam Therapy for Prostate Cancer: Results from a Multi-Institutional Study of the Japanese Radiation Oncology Study Group

1
Department of Radiation Oncology, University of Tsukuba, Faculty of Medicine, Tsukuba, Ibaraki 305-8576, Japan
2
QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Inage, Chiba 263-8555, Japan
3
Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Aichi 462-8508, Japan
4
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
5
Department of Radiation Oncology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
6
Proton Therapy Division, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka 411-8777, Japan
7
Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba 277-0882, Japan
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Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan
9
Medipolis Proton Therapy and Research Center, Ibusuki, Kagoshima 891-0304, Japan
10
Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Fukui 910-8526, Japan
11
Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
12
Department of Radiation Oncology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(6), 1690; https://doi.org/10.3390/cancers12061690
Received: 25 May 2020 / Revised: 19 June 2020 / Accepted: 23 June 2020 / Published: 25 June 2020
(This article belongs to the Special Issue Proton Therapy For Cancers)
Background: Androgen deprivation therapy (ADT) combined with radiation therapy benefits intermediate- and high-risk prostate cancer (PC) patients. The optimal ADT duration in combination with high-dose proton beam therapy (PBT) remains unknown. Methods: Intermediate- and high-risk PC patients treated with PBT combined with ADT for various durations were analyzed retrospectively. To assess the relationship between ADT and biochemical relapse-free (bRF) rate, Cox proportional hazards models including T stage, prostate specific antigen (PSA) level, Gleason score (GS), and total radiation dose were used. Results: In the intermediate-risk PC patients (n = 520), ADT use improved bRF (HR 0.49, 95% CI 0.26–0.93; p = 0.029), especially in those with multiple intermediate-risk factors (T2b–2c, PSA 10–20 ng/mL, and GS 7). In the high-risk PC patients (n = 555), a longer ADT duration (>6 months) conferred a benefit for bRF (HR 0.54, 95% CI 0.32–0.90; p = 0.018), which was most apparent in patients with multiple high-risk factors (T3a–4, PSA > 20 ng/mL, and GS ≥ 8) treated with ADT for ≥21 months. Conclusions: Short-term (≤6 months) ADT is beneficial for intermediate-risk PC patients, but likely unnecessary for those with a single risk factor, whereas ADT for >6 months is necessary for high-risk PC patients and ADT for ≥21 months might be optimal for those with multiple risk factors in combination of high-dose PBT. View Full-Text
Keywords: prostate cancer; androgen deprivation therapy; proton beam therapy; risk classification; radiation therapy prostate cancer; androgen deprivation therapy; proton beam therapy; risk classification; radiation therapy
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Murakami, M.; Ishikawa, H.; Shimizu, S.; Iwata, H.; Okimoto, T.; Takagi, M.; Murayama, S.; Akimoto, T.; Wada, H.; Arimura, T.; Sato, Y.; Gosho, M.; Nakamura, K.; Sakurai, H. Optimal Androgen Deprivation Therapy Combined with Proton Beam Therapy for Prostate Cancer: Results from a Multi-Institutional Study of the Japanese Radiation Oncology Study Group. Cancers 2020, 12, 1690.

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