HORMONAL PRETREATMENT DOES NOT AFFECT THE FINAL PATHOLOGICAL STAGE INLOCALLY ADVANCED PROSTATE-CANCER

Objective. To determine the effect of hormonal deprivation on final pa thologic stage in locally advanced prostate cancer. Methods. We studie d 34 patients with clinical stage B2 or C prostate cancer who underwen t androgen deprivation therapy before radical prostatectomy at the Uni versity of Colorado Health Sciences Center. Staging was primarily base d on digital rectal examination, transrectal ultrasound (TRUS), radion ucleotide bone scan, computed tomography (CT scan) of the pelvis, tran srectal coil magnetic resonance imaging (MRI), and measurement of seru m prostate-specific antigen (PSA). The majority of patients underwent laparoscopic lymph node dissection and 5 patients with positive nodes were excluded. Five patients were treated with oral flutamide (250 mg three times daily), the other patients received a combination of the d epot luteinizing hormone-releasing hormone analog leuprolide (7.5 mg) and flutamide (250 mg three times daily). Treatment duration was 4 mon ths. PSA measurement was repeated every 4 weeks and TRUS as well as en dorectal MRI was repeated prior to surgery. Results. Although serum PS A levels dropped significantly by 98% from a mean of 37.4 to 0.9 ng/mL (mean +/- SD), volume reduction of 50% occurred, and histopathologic changes as an effect of androgen deprivation could be observed in all patients; all but 1 patient had pathologic stage C disease. Conclusion . We conclude that the value, if any, of such an approach is limited r egarding the final pathologic stage. However, since 14 of 18 patients had an undetectable serum PSA after a mean follow-up of 15 months, the long-term effect of this concept warrants further study.