Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation

Background: The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer. Methods: Stage A(2), B or C prostate cancers were randomized to one of two groups: (i) group I (n = 90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) g roup II (n = 86), who underwent the surgery followed by 3 month androgen de privation and subsequent adjuvant endocrine therapy. The effects of preoper ative androgen deprivation on clinical relapse (serum prostate specific ant igen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA re lapse (PSA >0.2 ng/mL) were evaluated at 2 years after randomization. Results: There was no significant difference in clinical or PSA relapse-fre e survival and quality of life measures between the two groups, although re lapses occurred significantly more frequently in patients who had more adva nced stages, higher pretreatment PSA values or lower histologic differentia tion in either group. Subgroup analysis indicated that clinical relapse-fre e survival in stage C cancer tended to be better in patients with preoperat ive androgen deprivation than in those patients without it (P<0.1). Conclusions: Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant end ocrine therapy over the 2 year observation period. A longer follow up is ne eded to clarify the exact extent of benefit in terms of survival and qualit y of life.