Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockage in Clinical Stage B2 (T2bNxM0) Prostate Cancer

Abstract

The Journal of Urology 154 (1995) 424-428. doi:10.1016/S0022-5347(01)67067-8Received by publisher: 0000-01-01Harvest Date: 2016-01-04 12:20:26DOI: 10.1016/S0022-5347(01)67067-8Page Range: 424-42

Neoadjuvant hormonal therapy prior to radical prostatectomy: promises and pitfalls

“…The positive margin rate was 5.8%, lower than that reported after 3 months of NHT in similar cohorts of patients 34,36,37 (Figure 3). No cancer was identi®ed in the radical prostatectomy specimen in 13% of cases.…”

“…Randomized series that have documented surgical dif®-culty, blood loss, length of procedure, and postoperative complications found no signi®cant difference in these parameters between NHT-treated and untreated groups. 31,33 Apoptosis initiated by androgen withdrawal (or other stimuli elsewhere throughout the organism) is a controlled cellular event that is not associated with acute in¯ammation or scarring. However, one technical factor after 8 months of NHT is that the prostate can decrease to a small, fusiform swelling of the urethra which can make it more dif®cult to palpate the prostatic apex and decide where to take the dorsal bundle.…”

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

“…77 -81 This may be because the whole prostate shrinks, allowing wider resection margins, down-staging of the tumour itself or because of difficulties with accurate pathological assessment after hormonal treatment. 23 Either way, there is no evidence from long-term prospective randomized trials that neoadjuvant androgen deprivation has any effect on biochemical relapse 82,83 or survival. 84 Furthermore, difficulties may arise in giving the prostate specimen an accurate Gleason grade as androgen withdrawal affects the glandular architecture, so important prognostic information may be lost.…”

Use of androgen deprivation therapy in prostate cancer: indications and prevalence

“…Unfortunately, these studies did not reveal an improvement in long-term outcomes such as a survival benefit. [16][17][18] Other studies have evaluated longer duration of ADT. In a large, prospective phase III trial, the ability of 3 months vs. 8 months of neoadjuvant ADT to reduce PSA recurrence rates after radical prostatectomy was examined.…”