Complete Androgen Deprivation prior to Radical Prostatectomy in Patients with Stage T(3) Cancer of the Prostate

Endocrine Treatment prior to Radical Retropubic Prostatectomy in Patients with T₃ Prostate Cancer: A Retrospective Study of 22 Patients

“…A disparity between the pathological grading of the biopsy and the operative specimens is well known [3,7,17]. In 39% of our cases, the cancer grade was higher in the surgical specimen than in the needle biopsy.…”

“…They found beneficial effects of andro gen deprivation on primary tumor and metastases with tumor regression. There has been renewed interest in this topic by the possibility of downstaging stage T 3 prostate tumor by androgen deprivation before radical retropubic prostatectomy [2][3][4][5][6][7]. In our retrospective series of 22 patients with clinically diagnosed stage T3 prostate cancer treated with LH-RH agonists during a mean time of 5 months, regression of tumor was noted in all cases.…”

“…This finding is in accordance with other reports [3][4][5], Unfortunately, the histopathological sections of the prostatectomy speci mens did not confirm the striking clinical results, 89% showed evidence of extraprostatic disease. This indicates that despite the clinical finding of tumor downstaging after endocrine therapy, many patients will have persis tent locally advanced disease [4,5,7,8,12], It is therefore uncertain if the term downstaging is justified. On the other hand, Flamm et al [7] reported in their series an excellent downstaging rate of 33%.…”

“…This indicates that despite the clinical finding of tumor downstaging after endocrine therapy, many patients will have persis tent locally advanced disease [4,5,7,8,12], It is therefore uncertain if the term downstaging is justified. On the other hand, Flamm et al [7] reported in their series an excellent downstaging rate of 33%. However, already half of their downstaging cases presented with grade 1 tumors, whereas in our group no patient had a grade 1 tumor.…”

Issues on Early Diagnosis and Treatment of Localized Prostate Cancer

“…Scott and Boyd [25] in the 1960s used hormonotherapy to decrease the size of the prostate and change an inoperable lesion to a surgical excisable tumor. Results of this modality of combined therapy have been published [25], With the advent of complete androgen ablation, several authors have now utilized this modality of hormonal treatment to downsize the prostate prior to surgery [26][27][28][29]. Although most investigators use 3 months of therapy prior to sur gery, others believe that longer periods, up to 8 months, is ideal for most benefit [30], In most published series, a sig nificant decrease in PSA and in size of the prostate have been noted, which may facilitate surgery [26][27][28][29], How ever, other authors have not observed significant changes [31,32], Studies of radical prostatectomy specimens re moved following neoadjuvant hormone therapy show sig nificant downsizing and approximately 7-10% of patients without evidence of disease.…”