Induction androgen deprivation therapy before radical prostatectomy for prostate cancer--initial results

To determine if androgen deprivation therapy (ADT) on induction decreases the incidence of positive surgical margins and the subsequent risk of disease progression.

Between January 1992 and July 1994, 160 men with prostate cancer underwent radical retropubic prostatectomy (RP) and bilateral pelvic node dissection (PLND). Forty men (mean age 64.2 years) with either a higher clinical stage or a significant increase in serum prostate-specific antigen (PSA) level (P < 0.001) received induction ADT with a luteinizing hormone-releasing hormone (LH-RH) analogue alone (six patients), or with an anti-androgen (34 patients), 3-20 months before undergoing RP. The remaining 120 men (mean age 64 years) underwent surgery alone and served as historical controls. Prostatectomy specimens were evaluated using step-sections at 2-3 mm intervals and whole-mount reconstruction. The clinical and pathological results were compared.

There was a clinically significant decrease in the size of the prostate in almost all patients treated with ADT. After ADT the mean PSA level declined by > 95% from the levels before RP (P < 0.001). Of 40 men receiving ADT and the 120 controls patients, nine (22.5%) and 49 (40.8%) had positive margins (P < 0.05), nine (22.5%) and 18 (15%) had seminal-vesicle invasion (P = 0.90) and one (2.5%) and two (1.6%) had lymph-node metastases (P = 0.73), respectively. At a mean 17.6 months (range 2-29), 20 of the control patients were lost to follow-up. PSA levels were elevated (> 0.4 ng/mL) in seven (17.5%) of the men who received ADT and 14 (14%) of the control patients (P = 0.60). To date, all patients are alive.

The results of this study suggest that neoadjuvant ADT before RP is beneficial in men with a high likelihood of having a positive surgical margin. A prospective randomized trial is necessary to determine if there is a benefit in progression-free and overall survival.