Efficacy of neoadjuvant hormonal treatment before radical prostatectomy for high-risk clinically localised prostate carcinomas
Berczi Csaba dr., Dócs János dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)
Aims: To measure the efficacy of neoadjuvant hormonal therapy before multimodal treatment of patients with clinically localized high-risk prostate carcinomas.
Methods: From January 1996 to January 2019, 394 patients underwent radical prostatectomy for clinically localized high-risk prostate cancer. In Group 1 the patients neoadjuvant hormonal treatment (n: 98) was administered, while in Group 2 the patients didn’t receive any neoadjuvant hormonal treatment (n: 296). In Group 1, the mean age of the patients was 64.6 ± 6.1 years and the mean PSA level was 32.9 ng/mL. In Group 2, the mean age of the patients was 63.8 ± 6.4 years, and the mean PSA concentration was 25.4 ng/mL. In all cases the preoperative imaging examinations showed clinically localized prostate tumor.
Results: Histology revealed locally advanced tumor (pT3) in 36 cases (36.9%) in Group 1, and in 154 patients (52.0%) in Group 2 (p = 0.012). Margin positivity was detected in 18 patients (18.3%) in Group 1, while it was proved in 91 cases (30.7%) in Group 2 (p = 0.02).
The median follow-up period was 56 months. In Group 1, biochemical progression developed in 19 patients (19.3%). Local recurrence and distant metastasis were diagnosed in 3 cases (3.0%) and in 6 occasions (6.1%) during this period. In Group 2, biochemical progression was diagnosed in 41 cases (13.8%), local recurrence in 8 patients (2.7%) and distant metastasis in 7 occasions (2.3%). There was no significant difference regarding to these parameters in the two groups. Tumor specific mortality was 3.0% in both groups (p = 0.991).
Conclusions: The results showed that the neoadjuvant hormonal therapy provided significantly better local tumor control in clinically localized high-risk prostate carcinomas. However, the neoadjuvant hormonal therapy didn’t prove any advantage according to tumor progression and tumor specific survival.