Radical Prostatectomy: Palliation for Stage C Carcinoma of the Prostate

Tomlinson, R.L.; Currie, D. Patrick; Boyce, William H.

doi:10.1016/s0022-5347(17)58349-4

Cited by 101 publications

(24 citation statements)

References 13 publications

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“…Arguments against the extirpative procedure in locally advanced disease have been based on increased morbidi ty, mainly urinary incontinence [26]. The reported inci dence of postoperative urinary incontinence is however below 2% [ 10,27], In our study, there was no total loss of continence, 44% showed a slight stress incontinence.…”

Section: Discussioncontrasting

confidence: 46%

Endocrine Treatment prior to Radical Retropubic Prostatectomy in Patients with T<sub>3</sub> Prostate Cancer: A Retrospective Study of 22 Patients

1992

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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%.

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Section: Discussioncontrasting

confidence: 46%

Endocrine Treatment prior to Radical Retropubic Prostatectomy in Patients with T<sub>3</sub> Prostate Cancer: A Retrospective Study of 22 Patients

1992

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“…The goal of therapy in stage C prostate cancer is local control of the tumor and prolongation of the interval free of disease [65,66]. The present data show that local control of the disease was achieved rapidly in all except one patient (98.6%).…”

Section: Stage Csupporting

confidence: 47%

Combination therapy in stage C and D prostatic cancer: rationale and five-year clinical experience

et al. 1987

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In 1941, Huggins and his colleagues discovered that testicular androgens exert a stimulatory effect on prostate cancer growth. Our group has made the key observations that the human adrenals, in addition to the tests, also secrete important amounts of androgens and cancer cells exhibit a marked heterogeneity of androgen sensitivity. In fact, human adrenals secrete large amounts of precursor steroids that are converted into active androgens in peripheral tissues (including the prostate), thus providing 40% to 50% of total androgens in adult men. The action of these androgens remaining after castration can be inhibited in prostatic cancer tissue by administering a pure antiandrogen that also decreases the local concentration of dihydrotestosterone (DHT). The castration levels of serum testosterone left in men after castration have an important stimulatory activity on the growth of androgen-sensitive normal as well as cancer tissues. Cancer cells have markedly different requirements for androgens. Some cell clones can grow in the presence of minimal amounts of androgens, requiring more complete androgen blockade and more potent antiandrogens for inhibiting growth. Among the compounds recommended as antiandrogens, the most unexpected finding is that many of them are devoid of any antiandrogenic activity. In fact, medroxyprogesterone acetate, chlormadinone acetate, and megestrol acetate have androgenic activity, but do not inhibit the peripheral action of DHT in prostatic tissue. These compounds should not be classified as antiandrogens. Cyproterone acetate, on the other hand, is a mixed agonist-antagonist. The only compounds showing pure antiandrogenic activity are Flutamide and its analogues. There is thus a need for a more complete blockade of androgens of both testicular and adrenal origins in order to exert a maximal inhibitory effect on cancer growth. We have therefore performed clinical studies in previously untreated stage D2 and C prostate cancer patients with the combination therapy using the LHRH agonist [D-Trp6, des Gly NH2(10)] LHRH ethylamide and the antiandrogen Flutamide. There was a significant increase in patients with a complete response, as compared with studies limited to the removal or blockade of testicular androgens. There was also a significant decrease in the number of non-responders, an increased duration of positive response, and a decrease in the death rate. This was achieved with minimal or no side effects, thus preserving a good quality of life.

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“…The high incidence of lymph node métastasés (up to 60% according to the lit erature) is the most cited argument against operative treatment [1,5,6,10,20]. On the other hand, there are reports which clearly show that the results after radical prostatectomy for T3 tumors could not be attained by radiation or hormonal treatment [4,16,22], The inci dence of N2 métastasés was shown in a retrospective study of the AUO: in 13% (25 of 194) of all tumors and in 37% (26 of 70) of stage T3 tumors. Therefore, we do not see the stage as a limiting factor for the operation, especially under the aspect of the necessity for a lymph staging operation before radiation therapy and in consid eration of the argument that the lymph node dissection of Ni métastasés 'may be of a clinical benefit' [23].…”

Section: Discussionmentioning

confidence: 99%

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

Flamm¹,

Fischer²,

Höltl³

et al. 1991

Eur Urol

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Radical Prostatectomy: Palliation for Stage C Carcinoma of the Prostate

Cited by 101 publications

References 13 publications

Endocrine Treatment prior to Radical Retropubic Prostatectomy in Patients with T<sub>3</sub> Prostate Cancer: A Retrospective Study of 22 Patients

Endocrine Treatment prior to Radical Retropubic Prostatectomy in Patients with T<sub>3</sub> Prostate Cancer: A Retrospective Study of 22 Patients

Combination therapy in stage C and D prostatic cancer: rationale and five-year clinical experience

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

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