The counter regulatory increase in androgens may counterbalance any positive effect of the decrease in estrogens to preserve intraprostatic homeostasis.
Studienname Studienkoordinator Patienteneinschluû AP 06/95 (EC 507) U. W. Tunn PSA-Progression nach Radikaler Prostatektomie AP 17/95 J. E. Altwein M1 AP 19/96 (EC 210) J. M. Wolff D2/M1a
At present, only locally confined carcinoma of the prostate can be cured if all of the tumor tissue can be removed by surgery [36]. Early detection strategies using serum prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound (TRUS) have been increasingly used. However, exact clinical determination of the local tumor extension is only possible to a limited extent [4, 13, 28, 34]. Up to 60% of clinical locally confined tumors are understaged after histopathological examination of the radical prostatectomy specimen. Furthermore a high incidence of positive margins of up to 60% has been reported [7, 21]. Although a clear surgical margin does not exclude local or distant disease recurrence, it is regarded as a good prognostic factor [3, 25]. Androgen withdrawal prior to radical prostatectomy is an attractive theoretical option to decrease the risk of disease recurrence, since tumor regression can be induced by any procedure that reduces the intracellular concentration of dihydrotesterone by more than 80%. The benefit of preoperative medical androgen deprivation is controversial [6-8, 13, 15-17, 20, 23, 35, 37]. A priori a benefit would not be expected in any case if androgen withdrawal had no effect on the tumor. We therefore investigated the effects of a neo-adjuvant androgen-ablative therapy (NAT) in a large population of 375 patients who underwent radical retropubic prostatectomy (RRP) after NAT. We report in particular the effects of NAT on prostate volume measured by TRUS, PSA, clinical stage and tumor morphology including positive surgical margins. Furthermore the recently reported first results of prospective randomized trials comparing RRP alone versus NAT plus RRP are discussed to analyze the possible impact of NAT.
Pre-operative staging, using transrectal prostatic sonography and CT, was carried out in 30 patients with cytologically confirmed carcinomas of the prostate and the results compared with the clinical findings. All patients underwent radical prostatectomy and the pre-operative findings could be verified histologically. Transrectal prostatic sonography is better than CT or clinical examination for determining local tumour spread or penetration of the capsule. A high proportion of enlarged pelvic lymph-nodes shown by CT had non-specific changes; failure to demonstrate enlarged nodes excludes lymph node metastases with considerable certainty. Transrectal prostatic sonography provides a higher degree of information regarding local tumour spread, whereas CT indicates the presence or absence of lymph node metastases.
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