NEOADJUVANT ANDROGEN ABLATION THERAPY PRIOR TO RADICAL PROSTATECTOMY - RESULTS OF A 3-YEAR FOLLOW-UP

Our previously reported non-randomized clinical trial proved the abili ty of preoperative androgen ablation therapy (AAT) to decrease positiv e surgical margins and to downstage a subset of biopsy-proven stage T3 cancer. The present study focuses on the progression of the disease i n this group over a 3-year (mean) period. For 140 consecutive radical prostatectomies, this study evolved into comparisons of three groups: (1) 124 patients with clinically confined cancer given AAT; (2) 121 pa tients with clinical stage B not given AAT; (3) 16 patients with prove n stage T3 by transrectal ultrasound-guided biopsy and given AAT. Comp arison of AAT with no AAT resulted in positive surgical margin rates o f 14.5% vs 47.5%. For known stage T3/C, a 44% downstaging occurred wit h no evidence of diseases at 40 months (mean). The 56% with non-confin ed (persistent) cancer after AAT had progression usually by 1 year. Sp ecimen-confined disease had progression as measured by prostate specif ic antigen of 18% for AAT vs 10% when no AAT was given. Neoadjuvant AA T before radical prostatectomy decreased by threefold the rate of posi tive surgical margins. Long-term follow-up of these patients is to con tinue since present results are very promising.