Randomized, Prospective, Controlled Study Comparing Radical Prostatectomy Alone and Neoadjuvant Androgen Withdrawal in the Treatment of Localized Prostate Cancer

Goldenberg, S. Larry; Klotz, Laurence; Srigley, John R.; Jewett, Michael A.S.; Mador, David R.; Fradet, Yves; Barkin, Jack; Chin, Joseph L.; Paquin, Jean-Marie; Bullock, Martin

doi:10.1097/00005392-199609000-00004

Cited by 18 publications

(28 citation statements)

References 10 publications

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“…Androgen withdrawal therapy has been shown to lower positive margin rates when given before radical prostatectomy [17,18].…”

Section: Resultsmentioning

confidence: 99%

“…All patients were offered neoadjuvant androgen withdrawal therapy for 3±8 months before surgery under either the pilot projects conducted by the Division of Urology at UBC/VGH Prostate Centre or in randomized trials under the direction of the Canadian Urology Oncology Group [17,18]. The outcome measures included operative duration, estimated blood loss (EBL), number of blood transfusions, hospital stay, analgesic usage, surgical margin rates, and early and long-term complications.…”

Section: Methodsmentioning

confidence: 99%

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A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

Sullivan

Weir²,

Kinahan

et al. 2000

BJU International

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Objective To compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon. Patients and methods This unrandomized study included 138 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP), based on the speci®c conditions or the patient's choice; 79 patients (mean age 64.6 years) underwent RPP and 59 (mean age 61.7 years) RRP. Outcome measures included estimated blood loss, the incidence of blood transfusions, positive margins and complications, operative duration, analgesic use, days in hospital and quality of life. Results There was no difference in operative duration, and the incidence of positive margins or complications between the groups. The mean estimated blood loss in the RPP and RRP groups was 415 and 1138 mL, respectively. The RPP group stayed a mean of 2.2 days less in hospital and took 2.8 days less to regain a full diet than the RRP group; the RPP group needed 1.7 days before using oral analgesics and the RRP group 3.8 days. Of patients in both groups, 85% were pad-free at one year and their overall quality of life was similar. Conclusions The results of RRP and RPP are comparable; the advantages of the perineal approach include minimal blood loss, low-intensity postoperative nursing care, low analgesic use and earlier discharge from hospital.

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“…Androgen withdrawal therapy has been shown to lower positive margin rates when given before radical prostatectomy [17,18].…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

Sullivan

Weir²,

Kinahan

et al. 2000

BJU International

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“…However, no differences in biochemical or local recurrence rates have been demonstrated (Goldenberg et al, 1996;Klotz et al, 1999;Soloway et al, 2002). Criticisms of these randomised-controlled trials include the short duration of neoadjuvant treatment, lack of statistical power and lack of long-term follow-up.…”

Section: Adjuvant Hormonal Therapymentioning

confidence: 99%

Is there a role for chemotherapy in prostate cancer?

Canil

Tannock

2004

Br J Cancer

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There is evidence from randomised-controlled trials that patients with symptomatic hormone-refractory prostate cancer may experience palliative benefit from chemotherapy with mitoxantrone and prednisone. This treatment is well tolerated, even by elderly patients, although the cumulative dose of mitoxantrone is limited by cardiotoxicity. Treatment with docetaxel or paclitaxel, with or without estramustine, appears to convey higher rates of prostate-specific antigen response in phase II trials, but is more toxic. Large phase III trials comparing docetaxel with mitoxantrone have completed accrual. There is no role for chemotherapy in earlier stages of disease except in the context of a well-designed clinical trial. Chemotherapy has not been shown to alter survival in prostate cancer. However, in recent years, clinical trials have provided evidence for a palliative role of chemotherapy in patients with symptomatic hormone-refractory disease. In addition, new chemotherapeutic agents have shown promising results in phase II studies leading to enthusiasm for challenging the belief that chemotherapy does not alter the natural history of prostate cancer. In this article, we will review the role of chemotherapy during various stages of prostate cancer, using hypothetical case reports to illustrate our evidence-based discussion.

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“…B 2 disease, have been reported from several centres [1] and thus neoadjuvant androgen withdrawal therapy has With the increasingly common use of neoadjuvant androgen deprivation therapy before radical retropubic been evaluated in an attempt to reduce these rates and improve survival [2][3][4][5]. The results of randomized trials prostatectomy, a question that arises is whether there is a subset of patients with clinically localized prostate evaluating a 3-month course of neoadjuvant therapy before radical retropubic prostatectomy in patients with cancer which is unlikely to benefit from this approach.…”

Section: Introductionmentioning

confidence: 99%

“…To answer this question, we reviewed 87 patients underclinically localized prostate cancer revealed a significant decrease in the rate of positive margins [3][4][5]. These going radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized prostate cancer results have led to an enthusiastic acceptance of this therapeutic approach, even before the publication of over a 5-year period.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant androgen deprivation therapy before radical prostatectomy: who is unlikely to benefit?

Rabbani

Sullivan

Goldenberg

et al. 1997

British Journal of Urology

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Objective To determine which patients undergoing radical prostatectomy for localized cancer are unlikely to benefit from neoadjuvant androgen withdrawal therapy. Patients and methods Over a 5‐year period, 173 patients underwent radical retropubic prostatectomy; 87 patients received no pre‐operative androgen withdrawal therapy, for whom the clinical stages were T1b (17 patients), T1c (3), T2a (31) and T2b/c (36). Pre‐operative prostate biopsies contained well‐differentiated cancer in 43 and moderately differentiated cancer in 44 patients. Serum prostate‐specific antigen (PSA) ranged from 0.4 ng/mL to 110.1 ng/mL (median 5.0). The presence of extracapsular disease, positive surgical margins and seminal vesicle involvement were correlated with pre‐operative PSA, PSA density (PSAD), the natural logarithm of PSA [ln(PSA)], biopsy grade, clinical stage, and sparing of neurovascular bundles. Results Patients with a PSA ≤4.0 ng/mL had a rate of extracapsular disease and positive margins of 8.3% and none had seminal vesicle invasion; corresponding rates for patients with a PSA >4.0 ng/mL were 57%, 51% and 12%, respectively. Multivariate analysis revealed ln(PSA) to be the best predictor of extracapsular disease (P0.001), margin positivity (P0.001) and seminal vesicle invasion (P=0.0019). Conclusions These results suggest that in patients who have clinically localized, well or moderately differentiated prostate cancer, a PSA ≤4.0 ng/mL is predictive for organ‐confined disease. This group is unlikely to benefit from neoadjuvant androgen deprivation. Ln(PSA) may be able to improve the accuracy of mathematical multivariate models predicting the presence of extracapsular disease or margin positivity, but this will require verification in larger population‐based studies.

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Randomized, Prospective, Controlled Study Comparing Radical Prostatectomy Alone and Neoadjuvant Androgen Withdrawal in the Treatment of Localized Prostate Cancer

Abstract: Neoadjuvant androgen withdrawal with a 12-week course of 300 mg. cyproterone acetate daily results in a lower rate of positive margins without adversely affecting postoperative recovery. The impact on patient survival will be determined by long-term followup.

Cited by 18 publications

References 10 publications

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

Is there a role for chemotherapy in prostate cancer?

Neoadjuvant androgen deprivation therapy before radical prostatectomy: who is unlikely to benefit?

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