RADICAL PROSTATECTOMY AFTER COMPLETE ANDR OGEN BLOCKADE FOR STAGE-B2 AND STAGE-C CANCER OF THE PROSTATE

Despite recent advances in imaging techniques, the staging process is still unsatisfactory in cancer of the prostate. The underestimation fo r stage B2 and C tumours in about 50%. We present our findings in a re trospective study analyzing the clinical and biological effects of com plete androgen blockade before radical prostatectomy in patients with advanced stage localized tumours. We treated 21 patients from 1989 to 1993. All received preoperative homonotherapy by complete androgen blo ck for at least 3 months before node dissection preceding suprapubic r adical prostatectomy. Only 20 prostatectomies were peformed as metasta sis was found in the extemporaneous examination in 1 patient, The volu me of the prostate gland had diminished in all patients after the horm onotherapy (27.8%) as did PSA (95%). When evaluated, the tumour stage of the surgical specimen was always more advanced than the needle biop sy. Only 1 tumour was strictly limited to the intracapsule and all the others had either invaded the capsule, reached the margins or had inv aded the seminal vessels or lymph nodes. With a mean follow up of 45 m onths, recurrence rate is 50%, mainly due to tumours with positive mar gins or seminal invasion in patients who were not given adjuvant treat ment. Our results are in agreement with those in the literature showin g that although the volume of the prostate is reduced and PSA declines , no improvement in pathology staging is observed.