Neoadjuvant hormonal therapy in stage C adenocarcinoma of the prostate andincidence of biochemical recurrence

This report describes the effects of neoadjuvant hormonal therapy (NHT) in 31 patients with clinical stage T-3 adenocarcinoma of the prostate (CaP) wh o underwent radical prostatectomy (RP) and the incidence of biochemical rec urrence, as evidenced by serum prostate specific antigen (PSA) >0.2 ng/mL a fter RP, Twenty-six patients received combined androgen blockade consisting of a gonadotropin-releasing hormone (GnRH) agonist (leuprolide) and an ant iandrogen (flutamide), and the remaining five received flutamide alone. The mean Gleason score was 7.1 +/- 0.3, Five patients were found to have patho logic stage T-2c, 14 stage T-3a, 7 stage T-3b, and it stage T-3c disease. O ne specimen had no evidence of adenocarcinoma in the whole-mount specimen. The mean PSA concentration decreased from 25.4 ng/mL (Hybritech method) to 1.18 ng/mL, The prostate volume decreased a mean of 47%, and pathologic eff ects of hormonal deprivation were observed in all patients. Approximately 3 9% of the patients (12/31) demonstrated evidence of biochemical recurrence, with the mean time to biochemical failure being 28.9 months after NHT, Fol low-up ranged from 5 to 83 months with a mean of 52.7 months. Of the variab les studied (pretreatment PSA, Gleason score, final pathologic stage, and n adir PSA before surgery), pretreatment PSA (p = 0.001, Fisher's exact test) and pathologic stage T-3c (p = 0.012, Fisher's exact test) were found to h ave a statistically significant correlation with biochemical recurrence. Al though there was a 39% biochemical recurrence rate in our study, we conclud e that NHT offers an alternative mode of management for patients with stage T-3 CaP.