Effects of complete androgen blockade for 12 and 24 weeks on the pathological stage and resection margin status of prostate cancer

Abstract

Aims: To compare the pathological stage and surgical margin status in patients undergoing either immediate radical prostatectomy or 12 and 24 weeks of neoadjuvant hormonal treatment (NHT) in a prospective, randomised study. Methods: Whole mount sections of 393 radical prostatectomy specimens were evaluated: 128 patients had immediate surgery, 143 were treated for 12 weeks and 122 for 24 weeks with complete androgen blockade. Results: Histopathology revealed organ confined tumours in 40.4% of patients with clinical stage B disease in the immediate surgery group, whereas 12 and 24 weeks of NHT increased the number of organ confined tumours to 54.6% and 64.8%, respectively. Among patients with clinical stage C tumours, pathological staging found organ confined disease in 10.4%, 31.4%, and 61.2% in the immediate surgery, 12 weeks of NHT, and 24 weeks of NHT groups, respectively. Preoperative NHT caused a significant decrease in positive margins both in patients with clinical stage B and C disease. The extent of margin involvement was not influenced by preoperative treatment. Conclusions: Neoadjuvant androgenic suppression is effective in reducing both the pathological stage and the positive margin rate in patients with stage B and C prostatic cancer undergoing radical surgery. Some beneficial effects are evident in those patients treated for 24 weeks, and it is reasonable to assume that the optimal duration of NHT is longer than three months.

Role of Androgen Deprivation in Patients Undergoing Radical Prostatectomy

“…The proportion of pathologic organ confined disease [7][8][9][10] and negative lymph-node metastasis [7-9, 11, 12] was higher among the neoadjuvant ADT group in some trials. Although a longer duration of ADT (more than 3 months) showed better pathologic outcome in three trials, the data on recurrence and survival was not available from these studies [13][14][15]. Five trials reported the disease free survival (DFS) and none showed a significant difference in DFS [7,8,12,16,17].…”

Is the Post-Radical Prostatectomy Gleason Score a Valid Predictor of Mortality after Neoadjuvant Hormonal Treatment?

“…The German S3 guidelines underline, however, the adverse impact of such treatment on the histopathological workup and prognostic stratification [5]. Currently, the prognostic evaluation of patients who received neoadjuvant hormonal treatment relies only on the anatomical tumour stage and the margin status, factors that may be influenced by neoadjuvant hormonal treatment as well as the Gleason score [8,16,17]. Neoadjuvant hormonal treatment is occasionally used in multimodality approaches for high-risk tumours [18,19].…”

Pitfalls with MRI Evaluation of Prostate Cancer Detection

“…Neoadjuvant hormonal therapy was in fact performed for 25 of the 37 patients before the operation ( table 1 ) all but one receiving maximum androgen blockage (MAB: LH-RH agonist + anti-androgens) for 1-2 months (mean 1.5 months), the single exception being given LH-RH agonist alone. Patients who had received less than 3 months' treatment were considered acceptable for inclusion because of the low likelihood of major clinical effects within this period [11][12][13] .…”

“…Since there is a likelihood that long-term hormone therapy will reduce tumor size, the present cases were limited to patients receiving such a therapy for less than 3 months, it being generally accepted that 3 months or longer are necessary for hormone effects to become evident [11][12][13] .…”