[8-month neoadjuvant hormonal therapy before radical prostatectomy for high-risk prostate cancer].

Abstract

PURPOSE:

To evaluate the clinicopathological outcomes of 8 months of neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy for high-risk prostate cancer.

PATIENTS AND METHODS:

A multi-institutional prospective trial was performed between July 2000 and May 2003 involving high-risk prostate cancer patients without metastasis, including 21 who received 8 months of NHT before radical prostatectomy. High-risk group was defined as clinical stage > or =T2c and/or prostate-specific antigen (PSA) >20 ng/ml and/or Gleason score > or =8. PSA values were considered elevated (biochemical failure) if values of 0.1 ng/ml or greater were obtained.

RESULTS:

Median of initial PSA levels before prostate biopsy was 27.6 ng/ml (8.5-80.7 ng/ml), and median of pre-operative PSA levels after NHT was 0.28 ng/ml (0.02-4.2 ng/ml). There were 5 patients (23.8%) with lower limit of PSA detection (less than 0.02 ng/ml) in 8 months after NHT. The clinical T stage was T1c in 9 patients (42.9%), T2a-b in 8 patients (38.1%), T2c in 3 patients (14.3%), and T3a in 1 patient (4.8%). The median follow-up was 25 months (range 4 to 37). There were 2 patients (9.5%) in pT0, 5 patients (23.8%) with positive surgical margin, 5 patients (23.8%) with extracapsular extension (ECE) and 3 patients (14.3%) with seminal vesicle involvement (SVI). Biochemical failure was occurred in 9 of 21 (42.9%) including of one pT0. Range of time to postoperative biochemical failure was 2 to 25 months (median 6 months) and most of biochemical failure was found within 12 months after surgery. Biochemical failure rate was significantly higher in patient with positive SVI (p = 0.0308) and higher in patients with pre-operative PSA levels of more than 0.1 ng/ml (p = 0.0836), positive ECE (p = 0.0545) and positive surgical margin (p = 0.0545).

CONCLUSION:

Biochemical failure was frequent after this combined treatment, even in a pT0 case. Long-term follow-up of patients is needed to assess the impact of this therapy on mortality.

• Authors: Ken-Ichi Tabata, Takefumi Satoh, Kazumasa Matsumoto, Tetsuo Fujita, Akira Irie, Masatsugu Iwamura, Nobuyuki Yanagisawa, Daisuke Matsuda, Masatoshi Muramoto, Kazuomi Kadowaki, Kazuho Suyama, Kiyoshi Shoji, Hideshige Koh, Tatsuo Kawakami, Isao Okayasu, Shin Egawa, Shiro Baba
• Journal: Nihon Hinyokika Gakkai zasshi. The japanese journal of urology (Nihon Hinyokika Gakkai Zasshi) Vol. 97 Issue 5 Pg. 712-8 (Jul 2006) ISSN: 0021-5287 [Print] Japan
• PMID: 16898594 (Publication Type: Clinical Trial, English Abstract, Journal Article, Multicenter Study)

Chemical References

• Androgen Antagonists
• Anilides
• Antineoplastic Agents, Hormonal
• Biomarkers, Tumor
• Nitriles
• Tosyl Compounds
• Goserelin
• bicalutamide
• Prostate-Specific Antigen
• Leuprolide

Topics

• Aged
• Androgen Antagonists (administration & dosage)
• Anilides (administration & dosage)
• Antineoplastic Agents, Hormonal (administration & dosage)
• Biomarkers, Tumor (blood)
• Chemotherapy, Adjuvant
• Goserelin (administration & dosage)
• Humans
• Leuprolide (administration & dosage)
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Nitriles
• Prospective Studies
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (diagnosis, pathology, therapy)
• Risk
• Time Factors
• Tosyl Compounds
• Treatment Failure