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"Focused on the Prostate since 1996"

Preoperative androgen-deprivation therapy for clinical stage T3 prostate cancer (Amling, Zinke).

Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study.

[Anatomical and clinical effects of neoadjuvant hormonal treatment before
radical prostatectomy]

Preoperative androgen-deprivation therapy for clinical stage T3 prostate cancer
Semin Urol Oncol 1997;15(4):222-9

Amling CL; Blute ML; Bergstralh EJ; Slezak JM; Martin SK; Zincke H
Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, MN
55905, USA.

The widespread availability of luteinizing hormone-releasing hormone analogues has renewed interest in androgen-deprivation therapy (ADT) before radical prostatectomy. Neoadjuvant ADT in patients with clinically localized tumors has resulted in decreased margin-positive rates and increased rates of organ-confined disease. Unfortunately, the pathological effects of ADT in patients with locally advanced (cT3) prostate cancer have been less marked. This article reviews our experience with neoadjuvant hormonal therapy in patients with clinical stage T3 prostate cancer. In a case-control study of cT3 patients undergoing radical retropubic prostatectomy between 1985 and 1992, 72 patients receiving preoperative ADT were compared with a matched group of 144 untreated patients in terms of pathological outcome and long-term disease-free survival. A local downstaging effect in hormonally treated patients was suggested by lower rates of extracapsular extension, but only 31% had organ-confined disease. Hormonally treated patients showed no benefit in survival or disease progression compared with patients who did not receive this therapy. Although preoperative ADT may decrease the incidence of extracapsular extension in clinical stage T3 prostate cancer, our data suggest that it has no significant effect on survival or disease progression in patients with locally advanced disease. (38 Refs)

Cookson MS, Sogani PC, Russo P, Sheinfeld J, Herr H, Dalbagni G, Reuter VE, Begg CB and Fair WR.
British Journal of Urology 1997, 79: 432-438.

This was a prospective trial of 3 months of androgen deprivation therapy in 69 patients prior to radical retropubic prostatectomy for localized prostate cancer. The patients were compared to 72 patients undergoing radical retropubic prostatectomy (RRP) who declined neoadjuvant androgen deprivation therapy. In keeping with other similar studies the rates of organ-confined disease and margin-negative disease were higher in patients who had androgen-deprivation. However, at a median follow up of 35 months the biochemical failure was similar in both groups. Clearly long-term follow up is required to assess whether neoadjuvant androgen deprivation has any role to play in patients undergoing RRP.

AU - Tostain J; Versini P; Legon C; Li G; Ludot T; Castro R; Armand C;
Boucheron S
TI - [Anatomical and clinical effects of neoadjuvant hormonal treatment before
radical prostatectomy]
SO - Prog Urol 1997;7(4):570-8
AD - Service d'Urologie-Andrologie, Hopital Nord, Centre Hospitalo-Universita-
ire, Saint-Etienne, France.
AB - Neoadjuvant endocrine treatment before radical prostatectomy is
designed to reduce the positive margin rate and therefore the risk of
recurrence. It usually consists of complete androgen blockade for 3
months, but no consensus has been reached concerning the type of
blockade and the optimal duration. The main histological changes
consist of glandular atrophy with pycnosis and vacuolization of
tumour cells. These changes could reflect increased apoptosis. The
residual tumour is usually small. PIN become rare, raising the
problem of possible chemoprevention. The overall result is a markedly
increased frequency of intracapsular tumours and a reduction of at
least 50% of positive margins. However, some authors consider that
this is simply due to a more detailed histological examination. The
frequency of seminal vesicle and lymph node involvement does not
appear to be modified. Endocrine therapy could act on the apoptosis-
proliferation balance and also decrease the number of circulating
cells. However, the intermediate results of randomized studies are
contradictory. As improvement in overall survival remains the main
objective, only a longer follow-up will be able to clearly determine
the value or uselessness of neoadjuvant endocrine treatment before
radical prostatectomy. (80 Refs)