Neoadjuvant hormonal deprivation before radical prostatectomy

Hormonal deprivation by combination therapy before radical prostatectomy has been recently introduced. The main purpose of such treatment is to achieve downstaging, downgrading, improvement of surgical results, and prolonged survival. Our experience with the last 100 patients who underwent radical prostatectomy at our hospital, of whom 40 received complete androgen blockade (luteinizing hormone-releasing hormone (LHRH) superagonist and flutamide) before radical surgery, has shown a definitive decrease in prostatic volume of 40-50%. Of these 40 patients, 25 were clinical stage T2 and 15 stage T3 at diagnosis. The reduction in volume facilitates dissection of the prostate from close vulnerable structures, resulting in reduced blood loss and operating time. Also, return of urinary continence is more rapid. Combination therapy resulted in clinical downstaging in one third of the patients; at histopathology, upstaging occurred in 12.5% (5 of 40) of patients, compared with the expected 30-50% upstaging in patients untreated before surgery. Serum prostate specific antigen (PSA) dropped to undetectable levels in 59% of the patients 3 months after hormonal suppression. Among these, 80% had PT2, and only 13% had PT3, tumor; one patient had a PT0 tumor. On the other hand, all patients who still had PSA > 4 ng/ml after neoadjuvant combination therapy had stage PT3-PT4 disease. Histological changes were observed in both the non-neoplastic tissue and the prostatic carcinoma, with more marked effects in the latter. The surgical margins were positive in 32% of the treated patients, compared with 57% in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)