Primary Androgen Deprivation (Pad) Followed By Active Surveillance For Newly Diagnosed Prostate Cancer (Pc)

244 Background: Men undergoing local therapy (LT) with radiation or surgery incur substantial risk of permanent sexual, urinary and rectal toxicity. Active surveillance is only recommended for men with Low-Risk PC who have < 34% biopsy cores positive. Studies of PAD as an alternative to LT are sparse.Retrospective analysis of 102 men with localized PC administered 12 months of an LHRH agonist and antiandrogen (PAD) followed by immediate biopsy (BX1). Outcome assessed: The incidence of implementing further treatment with either LT or androgen deprivation (AD) if there was subsequent progression on active surveillance (PAS) or if BX1 was positive. Post PAD monitoring included quarterly PSA testing, follow-up biopsy and imaging with color doppler ultrasound and endorectal MRI. Participants were screened for heart disease and osteoporosis and monitored for changes in body weight, BP, liver enzymes, anemia, blood sugar and cholesterol. All received empiric bisphosphonates and 5-alpha reductase inhibitors and were instructed to eat a low fat diet and perform resistance exercise.Patient characteristics: D'Amico risk category (DRC) Low: n=22; Intermediate: n=30; High: n= 50. Baseline factors assessed as potential predictors of PAS: Age, PSA, PSA velocity, PSA nadir, Gleason, % core biopsies, stage, prostate volume, DRC. Baseline medians for the 102 men: Age 67.3, PSA 7.8, Gleason 3+4, Cores > 50%, stage T1c, prostate volume 45cc. 55 men had PAS and required LT and/or AD over a median of 7.3 years follow up. Type of treatment administered after PAS by DRC: Low: AD 1, LT 3. Intermediate: AD 5, LT 10. High: AD 15, LT 21. Two men developed clinical progression. There were no PC deaths. Four men died of other causes: lung CA, melanoma, emphysema and MI. Only DRC (p<0.01) and PSA nadir (p<0.04) predicted PAS (3 men had PSA nadir > 0.1 and all were positive at BX1).PAD frequently induces durable remissions in men with Low and Intermediate risk PC despite a high prevalence of > 50% core biopsies positive at baseline in this population. 38% of the 55 men with PAD elected additional AD rather than undergoing LT suggesting that for some men enduring the toxicity profile of AD was preferable to the perceived risks of LT.