LONG-TERM FOLLOW-UP OF STAGES T2-T3 PROSTATE-CANCER PRETREATED WITH ANDROGEN ABLATION THERAPY PRIOR TO RADICAL PROSTATECTOMY

Objective: Our previously reported non-randomized clinical trial prove d the ability of preoperative androgen ablation therapy (AAT) to decre ase positive surgical margins and to downstage a subset of biopsy prov en stage T3 cancer. This study focuses on progression of disease in th is group over a 4-5 year period Materials and Methods: This study grou p consisted of 258 consecutive radical prostatectomies that evolved in to three groups: 1) 124 patients with clinical stage T2b-c cancer give n AAT; 2) 118 patients with clinical stage T2a not given AAT; 3) 16 pa tients with proven stage T3 by TRUS guided biopsy and given AAT. Resul ts: Comparison of AAT (n=140) to no AAT (n=118) resulted in positive s urgical margin rates of 15.3% vs. 49.2%. Specimen confined disease had tumor progression as measured by serum prostate specific antigen of 1 6.9% (15/89) for AAT (pC.001) vs 10% (5/49) for no AAT (p=0.288). For known stage T3/C, 43.8% (7/16) downstaged, and 85.7% (6/7) were free o f disease at 46.7 mos (mean). The 56.3% with non-confined (persistent) cancer after AAT had progression usually by one year. Conclusion: Neo adjuvant androgen ablation therapy before radical prostatectomy decrea sed by 3-fold the rate of positive surgical margins (+SM). The vast ma jority of these patients with +SMs were treated with either external b eam radiation or AAT. A near two fold increase of specimen confined di sease was found in those given AAT (p<.001). However the rates of prog ression (16.9% and 10.2% respectively) were greater in the AAT though not statistically significant (p=0.288).