Hormone therapy prior to radical prostatectomy in patients with clinical stage C prostate cancer

Abstract

Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin-releasing hormone analog, goserelin acetate (Zoladex@; Zeneca Pharmaceuticals, Macclesfield, UK) plus an antiandrogen (flutamide). Based on digital rectal examination (DRE), reductions of the size of the prostate and the tumor were noted in 91.4% of patients. Ultrasound demonstrated a decrease in prostatic volume between 0% and 62.5% (median 31%). Prostate-specific antigen (PSA) levels (Hybritechm) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prostatectomy. Pathologically, only 9 patients (14.1%) had organ-confined disease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had positive lymph nodes (stage Dl). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml.Maximal androgen blockade for a period of 3 months in clinical stage C prostate cancer induces a notable reduction in prostate size ("downsizing"). A "downstaging" effect, as suggested by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.

Differential Androgen Deprivation Therapies with Anti-androgens Casodex/Bicalutamide or MDV3100/Enzalutamide versus Anti-androgen Receptor ASC-J9® Lead to Promotion versus Suppression of Prostate Cancer Metastasis

“…Earlier reports showed that the PSA level may not reflect the pathological stage progression in some PCa patients, whose PSA levels were below 0.5 ng/ml with nodal metastasis after ADT (29,30). Meanwhile, a recent clinical trial of abiraterone, a powerful drug that suppressed androgen biosynthesis, also found that although 79% of PCa patients have a decline in PSA level of 50% or more, 52% of PCa patients have either increased new bone lesions or increased intensity of existing bone lesions, which these investigators called "bone scan flare," after 4 months of treatment (31).…”