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Neoadjuvant hormonal ablative therapy before radical prostatectomy: a review. Is it indicated?
M J Scolieri1, A Altman, M I Resnick
1Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
The Journal of Urology
|October 12, 2000
Summary
Neoadjuvant hormonal therapy before prostatectomy did not significantly improve outcomes. This review found no benefit in reducing positive surgical margins, seminal vesicle invasion, or lymph node metastasis.
Area of Science:
- Urology
- Oncology
Background:
- Neoadjuvant hormonal ablation therapy is used to reduce positive surgical margins in radical prostatectomy.
- The efficacy and indication for this therapy remain under investigation.
Purpose of the Study:
- To review the literature and determine if neoadjuvant hormonal therapy is indicated and beneficial before radical prostatectomy.
Main Methods:
- A MEDLINE keyword search was conducted for randomized prospective articles.
- Data analyzed included positive surgical margins, seminal vesicle invasion, lymph node metastasis, surgical characteristics, and prostate-specific antigen-free survival.
Main Results:
- Neoadjuvant hormonal therapy decreased positive margins in 6 of 7 studies.
- No improvement was observed in seminal vesicle invasion, lymph node metastasis, or prostate-specific antigen-free survival.
- No significant differences were found in operative time, blood loss, transfusion, hospital stay, or complication rates.
Conclusions:
- Available literature does not support the routine administration of neoadjuvant hormonal therapy before prostatectomy.
- Current evidence indicates no significant improvement in oncological or surgical outcomes.