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

Abstract

Twenty-two patients with locally advanced prostatic carcinoma stage T₃, N₀, M₀ have been treated with LH-RH agonists during a mean time of 5 months prior to radical retropubic prostatectomy. Although tumors appeared to be confined to the organ in 68% of the patients after endocrine treatment, pathological examination of the surgical specimens showed in 89% evidence of extraprostatic disease, which questions the clinical impression of ‘downstaging’. A disparity between the tumor grade of the biopsy and that of the operative specimen as well as an increased size of tumor-involved lymph nodes despite endocrine treatment led us to speculate that a certain proportion of patients will bear the risk of disease progression during preoperative androgen deprivation. Furthermore, there was local recurrence early in the postoperative course and at the high rate of 39%.

The Risk of Malignancy in the Surgical Margin at Radical Prostatectomy Reduced Almost Three-Fold in Patients Given Neo-Adjuvant Hormone Treatment

“…Marked decreases in serum PSA concentrations and less pronounced decreases in prostate volume have been found in most neo-adjuvant studies [10,14,18]. In the present study, a prostate volume reduction of 42% was recorded, which is in accordance with figures reported from previous studies [10,14,18,19].…”

“…In the present study, a prostate volume reduction of 42% was recorded, which is in accordance with figures reported from previous studies [10,14,18,19]. As on average the tumour volume constitutes only about 10% of the total prostate volume, most of this volume reduction in fact represents an effect on the benign part of the gland [20],…”

Neoadjuvant Hormonal Deprivation before Radical Prostatectomy

“…However, apparent volume regression should not lead to less wide radical surgical excision by trying to preserve the neurovascular bundles leading to a potential risk of later increased local recurrence as observed in the series of Gobet et al [32], These clinical studies suggest that although most pa tients with cancer beyond the confines of the prostate did not show that the tumor pulls back into the gland, some patients showed a pronounced effect from neoadjuvant therapy evidenced by marked clinical and pathological regression of their lesions.…”