Neoadjuvant Hormonal Therapy in Stage C Adenocarcinoma of the Prostate and Incidence of Biochemical Recurrence

This report describes the effects of neoadjuvant hormonal therapy (NHT) in 31 patients with clinical stage T3 adenocarcinoma of the prostate (CaP) who underwent radical prostatectomy (RP) and the incidence of biochemical recurrence, as evidenced by serum prostate specific antigen (PSA) >0.2 ng/mL after RP. Twenty-six patients received combined androgen blockade consisting of a gonadotropin-releasing hormone (GnRH) agonist (leuprolide) and an antiandrogen (flutamide), and the remaining five received flutamide alone. The mean Gleason score was 7.1 +/- 0.3. Five patients were found to have pathologic stage T(2c), 14 stage T(3a), 7 stage T(3b), and 4 stage T(3c) disease. One specimen had no evidence of adenocarcinoma in the whole-mount specimen. The mean PSA concentration decreased from 25.4 ng/mL (Hybritech method) to 1.18 ng/mL. The prostate volume decreased a mean of 47%, and pathologic effects of hormonal deprivation were observed in all patients. Approximately 39% of the patients (12/31) demonstrated evidence of biochemical recurrence, with the mean time to biochemical failure being 28.9 months after NHT. Follow-up ranged from 5 to 83 months with a mean of 52.7 months. Of the variables studied (pretreatment PSA, Gleason score, final pathologic stage, and nadir PSA before surgery), pretreatment PSA (p = 0.001, Fisher's exact test) and pathologic stage T(3c) (p = 0.012, Fisher's exact test) were found to have a statistically significant correlation with biochemical recurrence. Although there was a 39% biochemical recurrence rate in our study, we conclude that NHT offers an alternative mode of management for patients with stage T(3) CaP.