Preoperative neoadjuvant androgen withdrawal therapy in prostate cancer: the Canadian experience

The goal of radical prostatectomy is the complete removal of all cancer cells--no more, no less. Unfortunately, this is not always possible, especially in men with higher risk pathologic features. It is recognized that preoperative staging underestimates the extent of disease in < or =66% of cases, and that positive margin rates may be as high as 30% to 60%. Over the past 7 years in Canada, researchers have been investigating therapies that optimize the complete extirpation of all cancer cells with a minimum of morbidity and mortality. An example of this therapy is the combined modality approach of shrinking the prostate and tumor with androgen withdrawal therapy before surgical removal. The availability of potent, reversible, and well-tolerated forms of medical castration, and the sensitivity of serum prostate-specific antigen as a marker of response to therapy, makes neoadjuvant hormone therapy before localized therapy possible and appealing. In this article, we will review the Canadian experience, from the laboratory to the clinic.