NEOADJUVANT HORMONAL DEPRIVATION IN PATIENTS WITH LOCALLY ADVANCED PROSTATE-CANCER

A total of 22 patients with locally advanced prostate cancer (stage B2 to C) was entered into a protocol for 3 months of preoperative hormon al deprivation. Of the patients 8 were judged to have clinical stage B 2 and 14 to have stage C disease. The protocol regimen consisted of da ily administration of flutamide (250 mg. orally 3 times per day) and l euprolide injection (7.5 mg. intramuscularly) every month. Patients wi th objective evidence of downstaging by prostate specific antigen (PSA ) levels and transrectal ultrasound were offered surgical therapy. Of the 22 patients 20 have completed the protocol and are evaluable, and 2 of them did not show significant downstaging and elected radiotherap y. Preoperative hormonal therapy produced an average 33% downsizing of the prostate gland as determined by transrectal ultrasound volumetric s. Decreases in serum PSA values were demonstrated from a pre-hormonal average of 30 mug./l. (range 0.7 to 97.7) to an average of 0.53 mug./ l. (range 0.2 to 5.7) after hormonal therapy. Of the 18 patients who u nderwent an operation after demonstrating significant downsizing 7 had pathologically confirmed stage B disease, 7 had stage C cancer and 4 had positive pelvic lymph nodes. Of the 8 clinical stage B2 cancer pat ients 4 had pathological stage B2 disease following the protocol. Of t he 12 clinical stage C cancer patients 3 had pathological stage B dise ase, 4 had positive pelvic lymph nodes and the remainder had pathologi cal stage C cancer. Thus, only 3 of 20 patients (15%) demonstrated pat hological downstaging from the clinical stage. Downsizing the prostate volume and PSA changes with hormonal therapy were not predictive of p atient outcome either alone or in combination. Preoperative hormonal t herapy did not appear to facilitate the surgical procedure. Patients c ompleting neoadjuvant hormonal therapy had an average estimated blood loss of 1,238 ml. and an average operating time of 183 minutes. A grou p of 20 consecutive patients with stage B2 prostate cancer who underwe nt radical prostatectomy without preoperative hormone therapy had an a verage estimated blood loss of 1,296 ml. and an average operating time of 171 minutes.