[Clinical and biological evaluation of the response to neoadjuvant hormone therapy before radiotherapy in nonmetastatic cancers of the prostate].
OBJECTIVE
The aim of this study was to evaluate the clinical and biochemical response to neoadjuvant hormonal therapy (NAHT) before radical external radiotherapy (EBRT).


METHODS
From June 1986 to June 1994, 105 patients with histologically proven and non-metastatic prostate adenocarcinoma (stage B2-C2) received a short induction hormonal therapy (median: 3 months) with a luteinizing hormone releasing hormone (LHRH) analog associated with an anti-androgen followed in all cases by EBRT (66 Gy). All patients underwent a prostate-specific acid (PSA) determination, pelvic computed tomography (CT) scan and bone scan before the combined treatment. Response, treatment toxicity and PSA concentration were analyzed after the NAHT, 3 months after the completion of radiotherapy and every 6 months there after. Relapse was defined by PSA elevations above 4 ng/mL or two consecutive elevation above 1 ng/mL.


RESULTS
Median follow-up was 52 months. According to the Withmore-Jewett clinical classification, 85 tumors were stage C. Pre-treatment PSA (PSAi) was above 20 ng/mL in 63.8% of the patients (median PSAi: 26 ng/mL). A clinical evaluation and a PSA determination (PSAPH) were both performed for all patients after NAHT. Most of the time, urinary obstructive symptoms disappeared with androgen ablation; tumor volume regression exceeded 50% in 99 cases and was complete in 50 cases. Median PSAPH was 0.6 ng/mL for the entire group. Clinical and biochemical tumor response were coherent: 84% of patients with clinical total remission had a PSAPH < 1 ng/mL. PSAPH value was significantly correlated with tumor stage and pre-treatment PSAi: among the 11 patients with a PSAPH > 4 ng/mL, ten were stage C and nine had a PSAi > 20 ng/mL. A PSAPH value exceeding 4 ng/mL predicted biochemical relapse (P < 0.0001).


CONCLUSIONS
We conclude that biochemical response to hormonal therapy has a major prognostic value before EBRT can help to identify patients for an adjuvant hormonal therapy.
Richaud
P
P
Service de radiothérapie, institut Bergonié, Bordeaux, France.
Salem
N
N
Gaston
R
R
Mauriac
L
L
Chacon
B
B
Bussières
E
E
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005485:Flutamide / Q000008:administration & dosage; D017273:Goserelin / Q000008:administration & dosage; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D048289:Imidazolidines; D016729:Leuprolide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D018931:Antineoplastic Agents, Hormonal; D007093:Imidazoles; D048289:Imidazolidines; D017273:Goserelin; C021277:nilutamide; D005485:Flutamide; D017430:Prostate-Specific Antigen; D016729:Leuprolide