PATHOLOGICAL STAGING AND BIOCHEMICAL RECURRENCE AFTER NEOADJUVANT ANDROGEN DEPRIVATION THERAPY IN COMBINATION WITH RADICAL PROSTATECTOMY INCLINICALLY LOCALIZED PROSTATE-CANCER - RESULTS OF A PHASE-II STUDY

Objectives To assess the pathological staging and biochemical progress ion-free survival (assessed using serum prostate-specific antigen leve l) of patients with clinically localized prostate cancer using neoadju vant androgen deprivation therapy (ADT) in combination with radical re tropubic prostatectomy (RRP). Patients and methods A prospective study was carried out on 69 patients with localized prostate cancer who wer e enrolled in a trial of 3 months of ADT followed by RRP (group 1). Th ese patients were compared with 72 patients matched for age and clinic al stage who declined ADT therapy and had RRP concurrently (group 2). Assignment to the individual treatment groups was thus determined by t he patient's preference and not the physician's selection. Pathologica l staging and biochemical progression-free recurrence were compared be tween the groups. Results The rate of organ-confined (pT2) tumours was 74% in group 1 and 49% in group 2 (P<0.01), and the rate of margin-ne gative tumours was 87% in group 1 and 64% in group 2 (P<0.01). Within a median follow-up of 35 months, there was no significant difference i n biochemical failure between the groups (P=0.37). Patients with pT2 d isease, regardless of treatment, had similar biochemical failure rates . In the patients with margin-positive disease, there was a significan tly higher biochemical failure rate in group 1(P=0.02). Conclusions Th e rates of organ- and specimen-confined disease were higher among the patients treated with ADT. The preliminary follow-up suggested that pa tients with pT2 disease after ADT have a biochemical progression-free recurrence rate similar to pT2 patients treated with RRP alone, Additi onally, high biochemical failure rates in patients with margin-positiv e disease after ADT may identify a subset of more biologically aggress ive tumours in need of early adjuvant treatment.