Outcome of Adjuvant versus Salvage Androgen Deprivation Therapy (ADT) with/without Radiotherapy Following Radical Prostatectomy for Prostate Cancer Patients with Adverse Pathologic Feature(s) or with Positive Regional Lymph Node Metastasis

Objective: To evaluate and compare the overall survival of patients after radical prostatectomy, who had high-risk feature(s) or regional lymph node metastasis compared to those who received adjuvant androgen deprivation therapy (ADT) and those who received salvage ADT. Materials and Methods: All patients with prostate cancer who had high-risk feature(s) or regional lymph node metastasis and who underwent radical prostatectomy at the Division of Urological Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2000 to November 2016 were retrospectively reviewed. Results: Five hundred and four patients were included. At 15 years, overall survival was 87.3% and 90.2% in the adjuvant ADT and salvage ADT groups, respectively (p = 0.955). Recurrence-free survival was 83.2% in the adjuvant group, and 26.8% in the salvage group (p<0.001). Metastasis-free survival at 15 years in the adjuvant group and the salvage group was 68.3% and 74.1%, respectively (p = 0.261). CVS-morbidity-free survival was 91.9% in adjuvant patients, and 82.8% in salvage patients (p = 0.333). Conclusion: No difference in overall survival between the adjuvant and salvage ADT groups was demonstrated at 15 years after therapy. The adjuvant ADT group had significantly better recurrence-free survival at 15 years. There was no statistically significant difference for metastasis-free survival or CVS-morbidity-free survival between groups. Keywords: Adjuvant androgen deprivation therapy, ADT, Salvage ADT, Prostate cancer, Post radical prostatectomy, Adverse feature