Neoadjuvant hormonal therapy in stage C adenocarcinoma of the prostate

This report describes the effects of neoadjuvant hormonal therapy on 16 patients (mean age = 65 y) with clinical stage C adenocarcinoma of the prostate (CaP) who underwent radical prostatectomy from December 1991 to June 1993 at the University of Colorado Health Sciences Center. Staging of CaP was determined by digital rectal exam, transrectal ultrasonography (TRUS), radionuclide bone scanning, abdominal and pelvic computed tomography scanning, transrectal coil magnetic resonance imaging, and serum acid phosphatase. Most patients underwent a laparoscopic lymph node dissection to rule out micrometastasis. Every patient was treated for 4 months with a combination of a gonadotrophin-releasing hormone (GnRH) agonist (Lupron) and an anti-androgen (flutamide, Eulexin). Serial prostate-specific antigen (PSA) levels, post-treatment prostate volume measured by TRUS, and whole-mount sectioning of the surgical specimen were studied. The PSA levels decreased from a mean of 39.1 ng/ml (Hybritech method) to a mean of 0.43 ng/ml; (p < 0.0001). Prostate volumes in all patients demonstrated a mean decrease of 52% (p < 0.0001), and pathological effects of hormonal deprivation were observed in all patients. By whole-mount sectioning of the radical prostatectomy specimens, 3 patients had organ-confined disease (stage B), 6 showed invasion of the capsule with surgical margins free of tumor (stage C1), 3 had extracapsular extension with positive surgical margins (stage C2), and 4 had extracapsular extension with seminal vesicle involvement (stage C3). We conclude that by downsizing and markedly decreasing serum PSA values, neoadjuvant hormonal therapy offers an alternative treatment for stage C carcinoma of the prostate.(ABSTRACT TRUNCATED AT 250 WORDS)