title: Does neoadjuvant androgen deprivation therapy before primary whole gland cryoablation of the prostate affect the outcome?
abstract: OBJECTIVE
  To evaluate the effect of neoadjuvant androgen deprivation therapy (NADT) on the outcomes for primary whole gland prostate cryoablation (CRYO). NADT before CRYO has sometimes been used for prostate volume reduction, with some theoretical benefit toward improving disease control. NADT has been shown to be beneficial for biochemical disease-free survival (bDFS) with radiotherapy but not in conjunction with radical prostatectomy.
  
  
  METHODS
  We retrospectively compared risk-stratified cohorts according to whether they had received NADT. bDFS was defined using the Phoenix criteria, and postoperative morbidity and complications were compared.
  
  
  RESULTS
  A total of 1761 men had undergone NADT before CRYO and 2727 had not. No differences were found in the incidence of postoperative incontinence, pad use, potency, or fistula formation. The rate of urinary retention at 12 months was slightly lower for those who had not undergone NADT (0.8% vs 1.2%, P = .015). No difference was found in bDFS between the NADT and non-NADT men (66.9% vs 66.5% at 5 years). When stratified by risk, however, a statistically significant difference was found between the NADT and non-NADT men only in the intermediate-risk cohort (71.3% vs 65.9%; P < .013).
  
  
  CONCLUSIONS
  bDFS was statistically similar between the NADT and non-NADT men, except in the intermediate-risk cohort, with slightly improved survival for those undergoing NADT. No significant difference was found in the complication rates. These data do not support the routine use of NADT for men undergoing primary whole gland cryoablation, although its use could be considered for men with larger prostates or men in the intermediate-risk category.
authors: Department of Urology, Eastern Virginia Medical School, Norfolk, VA. Electronic address: erik.grossgold@gmail.com.
authors: Erik
authors: E
authors: Grossgold
authors: Department of Urology, Eastern Virginia Medical School, Norfolk, VA.
authors: Robert
authors: R
authors: Given
authors: Department of Urology, Loma Linda University, Loma Linda, CA.
authors: Herbert
authors: H
authors: Ruckle
authors: Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: J Stephen
authors: JS
authors: Jones
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003452:Cryosurgery / Q000009:adverse effects; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care; D011467:Prostate; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists