[Neoadjuvant therapy of prostate carcinoma]

The concept of using endocrine therapy to shrink the prostate or its cancer preoperatively has the aim to make the cancer more amenable to complete resection by radical prostatovesiculectomy. Four large prospective, randomized phase-II-studies are published which studied the effect of neoadjuvant antiandrogenic treatment in comparison with a control without hormonal therapy. The results of these contemporary series are: 1. reduction in prostate volume, 2. significantly lower PSA-values at the time of surgery, 3. a decreased rate of positive surgical margins in patients with cT2-tumors. However, the neoadjuvant treatment does reduce neither the incidence of seminal vesical nor of lymph node involvement. Although the results of pathologic downstaging in T2-tumors are encouraging, long-term follow-up to monitor disease-free survival and overall survival is required to document the true benefit of the approach. Possible disadvantages are 1. the cost factor, 2. the side effects of treatment, 3. the delay of definitive treatment especially in case of tumor cell clones not sensitive to the hormonal approach.