[The role of neoadjuvant treatment prior to radical prostatectomy]

Preoperative hormonal therapy has been recently advocated, but remain controversial. The aim purpose is to achieve downstaging, downgrading and improvement of the surgical results. In the last 80 patients undergoing radical retropubic prostatectomy, 28 had preoperative androgen deprivation, for a period ranging from 2 to 12 months with a mean treatment time of 3 months. Medical castration was obtained with total androgen deprivation. Return to normal value of PSA level in 90% cases and to undetectable level (< 0.25) in 39% of cases, expressing probably reduction of the tumor activity. Total prostatic volume is reduced by 30-50% after three months of treatment. The operative procedure was facilitated by an easier dissection, reducing operative time and blood loss. Recovery of postoperative continence was achieved in a significantly shorter period of time (3 months) as compared with the untreated patients (9 months). Immediate continence was obtained in 70% of patients treated preoperatively. No tumor was found in one specimen but no change was observed in the histological grading of the tumor in all the patients. This present study indicates the interest of a large scale randomized study, in order to show the real benefits of neoadjuvant hormonal treatment in prostate cancer patients.