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Neoadjuvant hormonal treatment before radical prostatectomy

R B Watson¹, M S Soloway

¹Department of Urology, University of Miami School of Medicine, FL 33101, USA.

Seminars in Urologic Oncology

|May 1, 1996

Summary

Androgen deprivation therapy before prostatectomy reduces prostate size and PSA levels, decreasing positive surgical margins. However, it does not impact tumor grade or spread, and optimal treatment duration requires further study.

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Area of Science:

Urology
Oncology

Background:

Androgen deprivation therapy (ADT) is used before radical prostatectomy.
Studies show ADT decreases prostate volume and PSA levels.

Purpose of the Study:

To evaluate the impact of neoadjuvant hormonal therapy on prostate cancer treatment outcomes.
To identify patient candidates for neoadjuvant hormonal treatment.

Main Methods:

Review of randomized trials evaluating ADT before radical prostatectomy.
Analysis of effects on prostate volume, PSA, surgical margins, and tumor characteristics.

Main Results:

ADT consistently reduces prostate volume and PSA levels.
Hormonal pretreatment significantly lowers positive surgical margins.
ADT does not influence seminal vesicle extension, lymph node involvement, or tumor grade.
Fibrotic reactions may increase surgical difficulty but not complications.
Bothersome side effects of neoadjuvant hormonal therapy are limited in clinical trials.

Conclusions:

Neoadjuvant hormonal therapy can reduce prostate volume and positive surgical margins.
Further research is needed on optimal treatment duration and impact on disease-free survival.
Patients with specific clinical stage, PSA, and Gleason grade may benefit from neoadjuvant ADT.

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