[Anatomical and clinical effects of neoadjuvant hormonal treatment before radical prostatectomy]

Neoadjuvant endocrine treatment before radical prostatectomy is designed to reduce the positive margin rate and therefore the risk of recurrence. It usually consists of complete androgen blockade for 3 months, but no consensus has been reached concerning the type of blockade and the optimal duration. The main histological changes consist of glandular atrophy with pycnosis and vacuolization of tumour cells. These changes could reflect increased apoptosis. The residual tumour is usually small. PIN become rare, raising the problem of possible chemoprevention. The overall result is a markedly increased frequency of intracapsular tumours and a reduction of at least 50% of positive margins. However, some authors consider that this is simply due to a more detailed histological examination. The frequency of seminal vesicle and lymph node involvement does not appear to be modified. Endocrine therapy could act on the apoptosis-proliferation balance and also decrease the number of circulating cells. However, the intermediate results of randomized studies are contradictory. As improvement in overall survival remains the main objective, only a longer follow-up will be able to clearly determine the value or uselessness of neoadjuvant endocrine treatment before radical prostatectomy.