Neoadjuvant flutamide monotherapy for locally confined prostate cancer.
BACKGROUND
We compared the clinical effects and impact on quality of life (QOL) of patients who received a 3-month course of flutamide monotherapy before radical prostatectomy with those who received a 3-month course of luteinizing hormone-releasing hormone (LHRH) agonist monotherapy.


METHODS
Thirty-seven patients with non-metastatic prostate cancer were enrolled in this study (19, flutamide; 18, LHRH agonist). The rates of change of serum prostate-specific antigen (PSA) and testosterone levels, downsizing of prostate volume, the rate of organ confined disease, adverse effects and perioperative scores measured using the European Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire (EORTC-P) and the Sapporo Medical University Sexual Function Questionnaire (SMUF) were analyzed.


RESULTS
At radical prostatectomy, pathological variables were not significantly different in the two groups. Serum testosterone level was significantly higher (mean 359.2 compared to 10.5, P < 0.001), complete response rate of PSA (13% compared to 57%, P = 0.028) and rate of downsizing of prostate volume (mean, -17.7% compared to -35.4%, P = 0.038) were significantly lower in the flutamide group than in the LHRH group. After neoadjuvant hormone therapy, the scores on the sexual problem domain of EORTC-P (P = 0.033) and sexual desire score of SMUF (P = 0.021) were significantly higher in the flutamide group than in the LHRH group. At a median follow-up of 34 months after prostatectomy, biochemical failure-free survival rate in the flutamide group did not differ from that in the LHRH group.


CONCLUSIONS
This study suggests that flutamide monotherapy can be an acceptable modality as an option for neoadjuvant hormone therapy.
Yoshimura
Koji
K
Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan.
Sumiyoshi
Yoshiteru
Y
Hashimura
Takayuki
T
Ueda
Tomohiro
T
Kamiryo
Yoriaki
Y
Yamamoto
Akihiro
A
Arai
Yoichi
Y
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005485:Flutamide / Q000627:therapeutic use*; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D000726:Androgen Antagonists; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D005485:Flutamide; D017430:Prostate-Specific Antigen