MAXIMUM ANDROGEN DEPRIVATION PRIOR TO RADICAL RETROPUBIC PROSTATECTOMY IN PATIENTS WITH STAGE T-3 ADENOCARCINOMA OF THE PROSTATE

Eighty-two patients with stage T-3 carcinoma of the prostate were trea ted for 3 months prior to radical retropubic prostatectomy with a lute inizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor s ize was noted in all cases. Ultrasound demonstrated a decrease in pros tatic volume between 0 and 62.5% (median 32%). Prostate-specific antig en levels (PSA, Hybritech(R)) decreased substantially (mean PSA of 29. 5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). P athologically, only 15 patients (18.3%) had organ-confined disease (st age pT(2)), 44 (53.7%) had stage pT(3) tumors and 22 (26.8%) had posit ive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with s eminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the h istological grade was found in only 7 tumors, while an increase was no ted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T-3 prostate cancer after 3 months of maximum androgen deprivation. This c annot be confirmed pathologically. Prospective studies with this treat ment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.