HORMONAL TREATMENT BEFORE RADICAL PROSTATECTOMY - A 3-YEAR FOLLOW-UP

Purpose: Hormonal treatment administered before radical prostatectomy has been shown to decrease the rate of positive surgical margins. We d etermine whether preoperative hormonal treatment has any impact on the subsequent failure rate. Materials and Methods: We prospectively eval uated 122 patients with stages T1bNxM0 to T3aNxM0, grades 1 to 3 prost ate cancer, including 64 randomly assigned to immediate radical retrop ubic prostatectomy and 58 randomly assigned to radical retropubic pros tatectomy preceded by 3 months of pretreatment with a gonadotropin-rel easing hormone agonist. We performed intention to treat analysis on th e data with failure defined as lymph node involvement, serum prostate specific antigen greater than 0.5 ng./ml., or the need for postoperati ve hormonal or radiation adjuvant treatment. Results: The positive mar gin rate was 23.6 versus 45.5% in the pretreatment plus prostatectomy versus prostatectomy only groups (p = 0.016). There were 20 failures ( 34.5%) in the pretreatment plus prostatectomy subgroup and 26 (40.6%) in the prostatectomy only group (p = 0.48). A negative surgical margin was associated with a significantly lower risk of progression than a positive surgical margin (20.8 versus 50.0%, p = 0.0016), and progress ion was delayed by approximately 1 year after hormonal pretreatment. H owever, at a median followup of 38 months there was no difference in p rogression-free survival (p = 0.57). Conclusions: Although hormonal pr etreatment significantly decreased the positive margin rate, it did no t result in any difference in progression-free survival when followup exceeded 3 years. Thus, our current results do not support the routine administration of hormonal treatment before radical prostatectomy.