WHY NEOADJUVANT ANDROGEN DEPRIVATION PRIOR TO RADICAL PROSTATECTOMY IS UNNECESSARY

Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy has been advocated for downstaging of tumors and reducing the rates of pos itive surgical margins with the expectation that disease-free survival will be improved. Despite the apparent favorable impact on pathologic findings, randomized trials to date show no benefit of NHT in prostat e-specific antigen progression rates. Consequently, there is serious c oncern about the validity and biologic significance of the apparent do wnstaging and decreased rate of positive margins, and no evidence exis ts that there is improved time to progression and survival; therefore, the authors do not recommend NHT outside of a clinical trial.