title: [Prognostic factors in patients with prostatic cancer treated with neoadjuvant hormonal therapy and radical prostatectomy].
abstract: The high incidence of clinical understaging and positive margins in patients undergoing radical prostatectomy for prostate cancer has led to the use of neoadjuvant hormone therapy to reduce tumor volume.
  
  
  OBJECTIVE
  To determine the prognostic factors in patients with prostate cancer treated with hormone therapy and radical prostatectomy.
  
  
  METHODS
  80 patients received hormone therapy with LH-RH agonists and flutamide before undergoing radical prostatectomy. The clinical stage and serum PSA were determined before and after hormone therapy. Prostate volume was determined by transrectal US.
  
  
  RESULTS
  In 91% of the patients, PSA levels fell within the normal ranges (< 4 micrograms/l) after hormone therapy. Prostate volume diminished by 39% on average. There were no operative deaths. Histological analysis of the surgical specimen showed no tumor (pTO) in 10% of the cases. Sixteen cases (19.5%) had pelvic node invasion. Positive margins were found in 35% of stage 2 and 56% of stage 3 tumors. Seminal vesicle invasion was found in 35% of T2 and 84% of T3 tumors. Seventy-five percent of the cases with initial PSA levels < 10 micrograms/l had intracapsular (pT2) or pTO tumor. All cases with PSA > 25 micrograms/l had extraglandular tumor. A correlation was found between baseline PSA and incidence of positive-margins. The finding of undetectable PSA after hormone therapy is not a useful prognostic factor since 55% of the cases had extracapsular tumor.
  
  
  CONCLUSIONS
  Our results indicate that hormone therapy with LH-RH agonist and flutamide prior to radical prostatectomy in patients with prostate cancer is well-tolerated and has no severe side effects. Despite the high percentage of cases with undetectable PSA after hormone therapy, no correlation was found between reduction of PSA levels and tumor stage.
authors.affiliation: Servicio de Urología, Fundación Puigvert, Barcelona, España.
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio Mavrich
authors.forename: G
authors.initials: G
authors.lastname: Chéchile Toniolo
authors.forename: D
authors.initials: D
authors.lastname: Salinas Duffo
authors.forename: J
authors.initials: J
authors.lastname: Muñoz Plaza
authors.forename: Y J
authors.initials: YJ
authors.lastname: Sorraca Ibáñez
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005485:Flutamide / Q000627:therapeutic use*; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D005485:Flutamide
vernacular_title: Factores pronósticos en pacientes con cáncer de próstata tratados con hormonoterapia neoadyuvante y prostatectomía radical.