Comparative study of the impact of 3- versus 8-month neoadjuvant hormonal therapy on outcome of laparoscopic radical prostatectomy.

PURPOSE: To comparatively evaluate the effect of 3- versus 8-month neoadjuvant hormonal therapy (NHT) on laparoscopic radical prostatectomy (LRP) operative and postoperative parameters.

METHODS: We evaluated 55 patients with clinically localized prostate cancer treated by 3-month (25 patients, group-1), 8-month NHT (19 patients, group-2) and non-neoadjuvant therapy (11 patients, group-3) before LRP. Serum PSA levels and prostate volume were measured and evaluated monthly before operation. The operative and postoperative parameters were recorded and compared in the three different groups.

RESULTS: Transrectal ultrasound determined that prostate volume decreased 39.6% in group 1 and 35.4% in group 2 after 3-month NHT and a further 34.4% in group 2 after 8-month NHT. The mean prostate volume was significantly smaller after 8-month than 3-month NHT in group 2 (P < 0.05). Mean serum PSA decreased 97.8% in group 1 and 98.1% in group 2 after 3-month NHT. A further 72.9% PSA decrease was determined after 8-month NHT in group 2. There were no significant differences in the three groups with respect to mean operative time, mean blood loss, transfusion rate, operative difficulty, catheterization time, hospital time and complication rate (P > 0.05, respectively). Positive margin rate was significantly lower in the 3- or 8-month NHT group than in the non-adjuvant group (P < 0.05, respectively). However, there was no significant difference between the 3- and 8-month groups with respect to positive margin rate (P > 0.05).

CONCLUSIONS: The prolonged NHT (8-month) did not affect the operative or postoperative parameters. The LRP can be safely performed in patients after prolonged NHT. Prospective randomized studies are required to determine whether prolonged NHT reduces the risk of biochemical recurrence after LRP.