Neoadjuvant hormonal therapy before radical prostatectomy and risk of prostate specific antigen failure

Purpose: To date there is little information on the long-term effect of neo adjuvant hormonal therapy on prostate cancer progression. We performed a pr ospective study to determine whether patients with prostate cancer receivin g neoadjuvant hormonal therapy before radical prostatectomy (hormonal thera py group) have a lower risk of prostate specific antigen (PSA) failure than those treated with radical prostatectomy alone (prostatectomy group). We a lso evaluated whether type of neoadjuvant hormonal therapy and duration wer e associated with the risk of PSA failure. Materials and Methods: We followed 680 men initially treated for prostate c ancer with radical prostatectomy between January 1988 and December 1997 at our university hospital. Of the patients 292 received neoadjuvant hormonal therapy. Median followup was 38 months. Cox regression analysis was used to assess the association between neoadjuvant hormonal therapy and PSA failur e (greater than 0.3 ng./ml.) controlling for age, clinical stage, grade, in itial PSA and adjuvant therapies. Results: Surgical margins were positive less often in the hormonal therapy (25%) than the prostatectomy (47%) group (p = 0.0001), PSA failure was obse rved in 163 patients and the Ei-year failure rate was 33%. No difference in risk of PSA failure was observed overall between the hormonal therapy and prostatectomy groups (hazards ratio 0.94, 95% confidence interval 0.68 to 1 .30). Treatments with antiandrogen alone for any duration, and those combin ing antiandrogen and luteinizing hormone-releasing hormone analogue for 3 m onths or less were not associated with improved survival. However, patients receiving combined therapy for more than 3 months had a significantly lowe r risk of PSA failure than those treated with radical prostatectomy alone ( hazards ratio 0.52, 95% confidence interval 0.29 to 0.93). Conclusions: Prolonged neoadjuvant hormonal therapy combining antiandrogen- and luteinizing hormone-releasing hormone analogue may improve disease-free survival after radical prastatectomy.