Neoadjuvant hormonal therapy prior to radical prostatectomy

The US T-2b study Of 3 months of neoadjuvant hormonal therapy (NHT) showed a reduction in the likelihood of positive margins from 48% (control group) to 18% in the treated patients. Follow-up at 42 months shows that the cumul ative relapse rate (prostate specific antigen) for 129 patients having NHT was not statistically different from that of the 126 control patients. Beca use the T-2b study has been criticized for lacking central pathology review , we present a review of a series involving only one surgeon (MS) and one p athologist (FC) of NHT plus prostatectomy (109 patients) v prostatectomy al one (145 patients) with 24 months' follow-up. Positive margins were decreas ed from 38% in the untreated to 28% in the treated group, the only statisti cally significant difference in the results. Biochemical recurrence (PSA >0 .2 ng/mL) was higher in the treated group, reflecting selection of more agg ressive tumors for NHT, but the difference was not statistically significan tly. The incidence of extracapsular extension, seminal vesicle invasion, an d lymph node metastasis was similar in the two groups. The largest nonrando mized experience with NHT shows a decrease in the incidence of positive sur gical margins when used in high-risk patients with clinically localized car cinoma of the prostate. However, it does not have an impact on disease-free survival at a mean 24-month follow-up.