Maximum androgen deprivation prior to radical retropubic prostatectomy in patients with stage T3 adenocarcinoma of the prostate.
Eighty-two patients with stage T3 carcinoma of the prostate were treated for 3 months prior to radical retropubic prostatectomy with a luteinizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor size was noted in all cases. Ultrasound demonstrated a decrease in prostatic volume between 0 and 62.5% (median 32%). Prostate-specific antigen levels (PSA, Hybritech) decreased substantially (mean PSA of 29.5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). Pathologically, only 15 patients (18.3%) had organ-confined disease (stage pT2), 44 (53.7%) had stage pT3 tumors and 22 (26.8%) had positive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the histological grade was found in only 7 tumors, while an increase was noted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T3 prostate cancer after 3 months of maximum androgen deprivation. This cannot be confirmed pathologically. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.
Voges
G E
GE
Department of Urology, Mainz Medical School, Germany.
Mottrie
A M
AM
Fichtner
J
J
Mappes
C
C
Störkel
S
S
Stöckle
M
M
Hohenfellner
R
R
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005485:Flutamide / Q000627:therapeutic use; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D005485:Flutamide