Effect of neoadjuvant hormonal therapy on prostatic intraepithelial neoplasia and its prognostic significance

Purpose: We studied the effect of neoadjuvant hormonal therapy on prostatic intraepithelial neoplasia in patients undergoing radical prostatectomy and assessed the effect of prostatic intraepithelial neoplasia on disease recu rrence as measured by serum prostate specific antigen (PSA). Materials and Methods: A total of 278 patients with clinically localized pr ostate cancer were included in phase II and III studies evaluating radical prostatectomy alone versus radical prostatectomy following neoadjuvant horm onal therapy at Memorial Sloan-Kettering Cancer Center between October 1991 and August 1996. Patient data related to prostatic intraepithelial neoplas ia were analyzed. Results: Of 275 evaluable patients 145 (52.7%) had prostatic intraepithelia l neoplasia. Of 50 patients treated with neoadjuvant hormonal therapy (horm one group) 22 (44%) had a lower incidence of prostatic intraepithelial neop lasia compared to 69 of 80 controls (86.3%) (chi-square test p <0.0001), Of 262 patients (95.3%) with followup PSA 44 (16.8%) had PSA recurrence at a median followup of 32 months, with a median time to recurrence of 30 months . PSA recurrence was noted in 23 of 145 patients with compared to 21 of 130 without prostatic intraepithelial neoplasia (chi-square test p =0.95), and did not significantly differ between the hormone group (25 of 142, 17.6%) and controls (19 of 130, 14.6%) (chi-square test p = 0.45). Conclusions: While patients treated with neoadjuvant hormonal therapy had s ignificantly lower incidence of prostatic intraepithelial neoplasia, neithe r prostatic intraepithelial neoplasia nor neoadjuvant hormonal therapy sign ificantly affected PSA recurrence at a median followup of 32 months.