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

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

PATIENTS AND METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.