Neoadjuvant hormonal therapy for localized prostate cancer prior to curative radical prostatectomy - Advantage or disadvantage?

Introduction: The results of neoadjuvant hormonal therapy (NH) of localized prostate cancer have been discussed controversially in the literature rega rding downstaging, downgrading, local tumor control, disease-free survival and operability. We evaluated the effect of antiandrogen treatment prior to radical prostatectomy in our patients. Method: In a retrospective analysis we analyzed 503 patients with radical p rostatectomy. Of these, 75 received a maximal androgen blockade for over 3 months prior to operation. The pre- and perioperative parameters - PSA-valu e, systematic prostatic biopsy, pathological staging and operation time, in traoperative blood loss, and in-patient stay - as well as follow-up informa tion were analyzed statistically. Results: Prognostically the group with NH had more unfavourable staging par ameters (PSA-value = 16,7 ng/ml, number of positive cores in the sextant bi opsy = 3.6) as compared to patients without NH (PSA 10.9, 2.6 biopsy cores) . Despite this the rate of organ-confined prostate cancer was higher in the pretreated group (65.1 % vs. 51.7 %). The Kaplan-Meier analysis demonstrat ed a higher progression rate for less than or equal to pT2b tumors after NH . Locally advanced tumors (greater than or equal to pT3a) had a comparable progression rate with and without NH. There were no differences in the rate of positive surgical margins. The group with NH showed a significantly hig her rate of lymph node involvement and tumor grading. Operability (operatio n time, blood loss and inpatient time) was identical in the two groups. Conclusion: In our patients we found downstaging after neoadjuvant hormonal therapy of localized prostate cancer, but no reduction of positive surgica l margins or downgrading. The effect of downstaging does not translate into an improvement in disease-free survival. There is a cosmetic effect withou t any benefit to the patient or physician. Neoadjuvant androgen blockade in the described form previous to radical prostatectomy has to be rejected.