[Predictive factors of locally advanced disease in patients with prostatic cancer treated with neoadjuvant hormone therapy and radical prostatectomy].
OBJECTIVE
To analyze the predictors of local adverse pathological findings (positive surgical margins and seminal involvement) in prostate cancer patients treated with neoadjuvant hormonotherapy and radical prostatectomy.


METHODS
We studied seventy-eight patients treated with neoadjuvant androgen blockade prior to radical prostatectomy between 1995 and 1998. Age, PSA, prostate volume determined by transrectal ultrasound and/or magnetic resonance imaging, clinical stage, Gleason score, duration of blockade, pathological stage and tumoral volume were analyzed.


RESULTS
34.6% of patients (27/78) had adverse pathology (odds: 0.53). No significant differences were found in age, PSA, prostate volume, duration of blockade and Gleason score between organ-confined and locally advanced patients. Differences were found in tumor volume (p = 0.0001) but this was not different in order to positive or negative digital rectal examination (p = 0.5334). The efficacy for predicting pathological adverse findings was represented by ROC curves (PSA: 0.628, clinical stage: 0.612 and Gleason score: 0.545). Predictive table of extracapsular disease for different PSA levels, clinical stage and Gleason score were developed. No variable predicted positive margins in logistic regression model.


CONCLUSIONS
Clinical variables do not predict locally advanced disease in prostate cancer patients treated with neoadjuvant androgen blockade. This is associated with higher tumor volumes. The probability of positive margins or seminal involvement increases with PSA level and Gleason score.
Lorente Garin
J A
JA
Servicio y Cátedra de Urología, Hospital del Mar, UAB, Barcelona.
Arango Toro
O
O
Bielsa Gali
O
O
Cortadellas Angel
R
R
Gelabert-Mas
A
A
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D012680:Sensitivity and Specificity
D018931:Antineoplastic Agents, Hormonal