Neoadjuvant androgen deprivation before radical prostatectomy. A review

Neoadjuvant androgen deprivation (NAD) using LH-RH analogues and antiandrogens before radical prostatectomy has been the object of several randomized trials over the last decade. From the pathological point of view they show that this treatment causes a significant reduction in the incidence of positive surgical margins compared to patients undergoing only surgery, and the optimal duration of preoperative treatment has not been determined yet. However the incidence of seminal vesicle invasion and metastases to the pelvic lymph nodes does not differ compared to controls. From the point of view of surgical technique no differences in operative time and blood loss have been recorded, while patients receiving NAD tend to present more difficult surgical dissections. The studies with longer follow-up uniformly fail to reveal an advantage in terms of PSA progression for treated patients, while data on cancer-specific survival have not been reported yet. Therefore the available information indicates that NAD before radical prostatectomy should not be considered outside clinical trials.