Neoadjuvant chemotherapy and hormonal therapy followed by radical prostatectomy: Feasibility and preliminary results

Purpose: We assessed the feasibility and efficacy of integrating chemothera py and androgen ablation with radical prostatectomy in patients with locall y advanced prostate canter. The neoadjuvant approach wets adopted because i t allows an in situ assessment of antitumoral activity, Patients and Methods: Thirty-three patients were enrolled who met the clini cal criteria of stage T1-2, Gleason score of greater than or equal to 8 or T2b-T2c, Gleason score of 7 and prostate-specific antigen (PSA) lever great er than 10 ng/mL (n = 15), or clinical stage T3 (n = 18), Therapy consisted of 12 weeks of ketocanazole and doxorubicin alternating with vinblastine, estramustine, and androgen ablation followed by prostatectomy, The ability of neoadjuvant chemotherapy and hormonal therapy to induce a 20% rate of pT 0 in the prostatectomy specimen as weft as surgical feasibility were assess ed. Results: Chemotherapy complications were comparable to chose reported with this regimen previously. No major intraoperative complications occurred, Po st-operative complications occurred in 10 (33%) of 30 patients. One patient died at home after discharge (postoperative day 17; no autopsy was perform ed). Ten (33%) of the 30 patients had organ-confined disease, and 20 (70%) of 30 had extraprostatic extension; 11 (37%) of the 30 had positive lymph n odes, Only five (17%) of 30 exhibited positive surgical margins. All patien ts achieved an undetectable PSA level postoperatively, and 20 of ate surviv ing 29 patients remain without disease recurrence with a median follow-up o f 13 months (range, 9 to 18 months). Conclusion: Chemotherapy and androgen ablation followed by radical prostate ctomy wets feasible in patients with locally advanced prostate cancer. Alth ough the goal of achieving a 20% rate for pT0 status was not achieved, we b elieve this type of integrated therapeutic strategy should be investigated further for its ability to alter the course of regionally advanced prostate cancer. J Clin Oncol 18:1050-1057, (C) 2000 by American Society of Clinica l Oncology.