Luteinizing Hormone-Releasing Hormone Downstaging of Clinical Stage C Prostate Cancer

Kennedy, Timothy J.; Sonneland, Arthur M.; Marlett, Myron M.; Troup, Richard H.

doi:10.1016/s0022-5347(17)37414-1

Cited by 31 publications

(8 citation statements)

References 10 publications

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“…Treat ment regimens in this group of patients were not uniform and postoperative radiation therapy was administered to some. In the last 5 years, several investigators have employed a reversible form of androgen deprivation prior to radical prostatectomy in patients with stages A-D (T i-N+) disease with varying results [9,13,14,[23][24][25][26][27][28][29][30][31][32] (ta ble 3). In 1 of the 15 patients with organ-confined disease, recurrent tumor was detected 2 years after the operation, all others were free of biochemical or clinical recurrence at the last follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Reasons for the continuing controversy as to what con stitutes the best treatment for patients with cancer outside the natural boundaries of the prostate are numerous and include the nonuniformity and subjectivity of staging and Between 1944 and 1969, a few reports described the use of hormonal therapy followed by radical prostatecto my [5][6][7][8]. Only recently, the interest in this form of treat ment has been revived and preliminary results of some studies treating patients with stage A-D disease have shown a promising effect of androgen deprivation before proceeding with radical prostatectomy [9][10][11][12][13]. It has been suggested that this neoadjuvant treatment was able to induce a stage reduction ('downstaging') of the disease in a notable number of cases and several prostatectomy specimens were even without residual tumor [10,14,15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Maximum Androgen Deprivation prior to Radical Retropubic Prostatectomy in Patients with Stage T(3) Adenocarcinoma of the Prostate

Voges¹,

Mottrie²,

Fichtner³

et al. 1995

Eur Urol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maximum Androgen Deprivation prior to Radical Retropubic Prostatectomy in Patients with Stage T(3) Adenocarcinoma of the Prostate

Voges¹,

Mottrie²,

Fichtner³

et al. 1995

Eur Urol

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“…Table 4 summarizes several series of 32.4%). Finally, a randomized intergroup study reported by Soloway et al showed a significant difference in patients with stage C disease treated with ADT [23][24][25][26][27][28][29]. From these studies, the overall rate of organ-confined favour of ADT for decreased positive surgical margins (18% versus 48%, respectively) [34].…”

Section: Between July 1991 and December 1992 A Total Of 75mentioning

confidence: 99%

Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study

Cookson

Sogani

Russo

et al. 1997

British Journal of Urology

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Objectives To assess the pathological staging and biochemical progression‐free survival (assessed using serum prostate‐specific antigen level) of patients with clinically localized prostate cancer using neoadjuvant androgen deprivation therapy (ADT) in combination with radical retropubic prostatectomy (RRP). Patients and methods A prospective study was carried out on 69 patients with localized prostate cancer who were enrolled in a trial of 3 months of ADT followed by RRP (group 1). These patients were compared with 72 patients matched for age and clinical stage who declined ADT therapy and had RRP concurrently (group 2). Assignment to the individual treatment groups was thus determined by the patient's preference and not the physician's selection. Pathological staging and biochemical progression‐free recurrence were compared between the groups. Results The rate of organ‐confined (pT2) tumours was 74% in group 1 and 49% in group 2 (P<0.01), and the rate of margin‐negative tumours was 87% in group 1 and 64% in group 2 (P<0.01). Within a median follow‐up of 35 months, there was no significant difference in biochemical failure between the groups (P=0.37). Patients with pT2 disease, regardless of treatment, had similar biochemical failure rates. In the patients with margin‐positive disease, there was a significantly higher biochemical failure rate in group 1 (P=0.02). Conclusions The rates of organ‐ and specimen‐confined disease were higher among the patients treated with ADT. The preliminary follow‐up suggested that patients with pT2 disease after ADT have a biochemical progression‐free recurrence rate similar to pT2 patients treated with RRP alone. Additionally, high biochemical failure rates in patients with margin‐positive disease after ADT may identify a subset of more biologically aggressive tumours in need of early adjuvant treatment.

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“…Previous studies with gonadotrophin-releasing hormone (GnRH) agonists, which act by preventing luteinizing hormone (LH) release therefore reducing serum testosterone levels, have shown some success in reducing tumor volume in patients with carcinomas at stages B and C [4][5][6]. A reduction in the incidence of positive surgical margins has also been demonstrated with LH agonists, although long-term follow-up of patients is required to assess the effects on mortality [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Hormone Treatment with Leuprolide Acetate Depot 3.75 mg and Cyproterone Acetate, before Radical Prostatectomy: A Randomized Study

Prezioso

Lotti²,

Polito³

et al. 2004

Urol Int

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Objectives: To assess the effect of neoadjuvant hormone treatment before radical prostatectomy on: tumor/prostate volume, prostate-specific antigen (PSA) and testosterone levels, surgical margin status and tumor stage, and the ease of surgery following treatment. Methods: Patients with clinically localized prostatic carcinoma were randomized to receive leuprolide acetate depot 3.75 mg once a month for 3 months and cyproterone acetate 300 mg once a week for 3 weeks prior to surgery (group A). A control group of patients had surgery without any pretreatment (group B). Results: 167 patients were evaluated for the efficacy parameters. In group A, 31% of patients had a reduction in tumor/prostate volume following hormone therapy. PSA and testosterone levels were significantly reduced (p = 0.0001) in patients in group A compared to basal values. Centralized histopathological data evaluated in 145 patients (group A and 75 group B) showed that more patients in group B had tumors at stages T3A and T3B than in group A; this difference was close to significance (p = 0.057). Positive surgical margins were more common in group B (60% of patients) compared to group A (39% of patients). Similarly lymph node involvement was more common in group B compared to group A (11 versus 3%). There was little difference between the 2 study groups for the other surgical parameters assessed (ease of dissection, duration of surgery, blood loss). Conclusions: Neoadjuvant hormone therapy before radical prostatectomy has some effects in the treatment of prostate cancer. However, long-term follow-up of patients is needed to assess the impact of this therapy on morbidity and mortality.

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Luteinizing Hormone-Releasing Hormone Downstaging of Clinical Stage C Prostate Cancer

Cited by 31 publications

References 10 publications

Maximum Androgen Deprivation prior to Radical Retropubic Prostatectomy in Patients with Stage T(3) Adenocarcinoma of the Prostate

Maximum Androgen Deprivation prior to Radical Retropubic Prostatectomy in Patients with Stage T(3) Adenocarcinoma of the Prostate

Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study

Neoadjuvant Hormone Treatment with Leuprolide Acetate Depot 3.75 mg and Cyproterone Acetate, before Radical Prostatectomy: A Randomized Study

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