Computed tomography/magnetic resonance based volume changes of the primarytumour in patients with prostate cancer with or without androgen deprivation

Background and purpose: To evaluate changes of the volume of the cancerous prostatic gland during androgen deprivation (AD) started immediately after diagnosis (IAD). Hypothetically, these data would assist the radiotherapist to determine the appropriate duration of pre radiotherapy downsizing neoad juvant luteinizing hormone releasing hormone (LHRH) treatment. A second aim was to assess any increase of the prostatic volume during the Ist year of diagnosis in patients who were allocated to a deferred treatment policy (DA D). Methods and patients: Thirteen patients in the IAD cohort and 13 patients i n the DAD group, all with T1-3pN1-2M0 prostate cancer, had regular computed tomography/magnetic resonance (CT/MR) examinations during the Ist year aft er randomization within the EORTC-GU trial 30846. Pre-treatment prostate sp ecific antigen (PSA) values were available in only 12 patients. Results: In the IAD group the prostate gland decreased with significant dif ference as compared with the DAD patients (P = 0.033). As compared with the pre-treatment situation the prostate gland in the IAD group was reduced in size by 18, 35, and 46% at 1, 6, and 12 months, respectively. In four of s ix evaluable IAD patients the prostatic volume continued to shrink after ac hievement of the nadir PSA level (at 3 months). In three of the 13 DAD pati ents the prostate volume increased by >25% during the Ist 3 months after ra ndomization. Conclusions: If neoadjuvant androgen deprivation is applied before local tr eatment to downsize the volume of the cancerous prostate gland, our limited data suggest that such treatment should last at least 6 months in order to achieve a maximal effect in the majority of patients. In about 1/4 of untr eated patients an increase in the prostate volume by >25% may occur within 3 months of diagnosis. If no AD is given, radiotherapy should start within this period. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.