HORMONE-THERAPY PRIOR TO RADICAL PROSTATECTOMY IN PATIENTS WITH CLINICAL STAGE-C PROSTATE-CANCER

Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin-releasing hormone analog, g oserelin acetate (Zoladex(R); Zeneca Pharmaceuticals, Macclesfield, UK ) plus an antiandrogen (flutamide). Based on digital rectal examinatio n (DRE), reductions of the size of the prostate and the tumor were not ed in 91.4% of patients. Ultrasound demonstrated a decrease in prostat ic volume between 0% and 62.5% (median 31%). Prostate-specific antigen (PSA) levels (Hybritech(R)) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prosta tectomy. Pathologically, only 9 patients (14.1%) had organ-confined di sease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had pos itive lymph nodes (stage D1). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatmen t were below 0.5 ng/ml. Maximal androgen blockade for a period of 3 mo nths in clinical stage C prostate cancer induces a notable reduction i n prostate size (''downsizing''). A ''downstaging'' effect, as suggest ed by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit c oncerning local and distant cancer control and survival. (C) 1994 Wile y-Liss, Inc.