Influences of Neoadjuvant Androgen Ablation before Radical Prostatectomy on Positive Surgical Margin and Biochemical Recurrence Rate

Park, Eun Ki; Chung, Byung Ha; Hong, Sung Joon

Abstract

PURPOSE: For patients with a localized prostate cancer, the effects of neoadjuvant hormonal therapy are controversial. We evaluated the resection margin status and progression-free survival in high-risk patients (clinical stage T3 or greater, and/or Gleason score 8 to 10, and/or serum PSA greater than 20ng/ml) who did and did not receive neoadjuvant hormonal therapy prior to radical prostatectomy.
MATERIALS AND METHODS
Between May 1995 and May 2003, among patients who underwent radical retropubic prostatectomy for clinically confirmed adenocarcinoma, follow-ups were performed on 110 patients. Twentyeight patients of these received preoperative neoadjuvant hormonal therapy. Sixteen patients received neoadjuvant hormonal ablation among the 43 high-risk patients who were enrolled. Follow-up evaluations measured serum PSA every 3 months for 1 year postoperatively and every 6 months thereafter. Biochemical recurrence was defined as a level of serum PSA of 0.2ng/ml or greater on 2 consecutive evaluations.
RESULTS
Thirty-nine patients (35.5%) had positive surgical margins, and 23 patients (20.9%) showed biochemical recurrence. Positive surgical margins were less common in the neoadjuvant hormonal therapy arm (17.9% versus 41.5 %, p=0.019). However, there was no difference in the biochemical recurrence rate during the last follow-up (17.9% versus 22%, p=0.642). Positive surgical margins were less common in the high-risk patients with a neoadjuvant hormonal therapy arm than in the high-risk patients with a radical prostatectomy alone arm (25% versus 66.7%, p=0.008). Also, there was no difference in the biochemical recurrence rate during the last follow-up (45.4% versus 48.1%, p=0.2922).
CONCLUSIONS
Although androgen deprivation before radical prostatectomy resulted in an apparently significant decrease in positive surgical margins, there was no difference between the biochemical recurrence rates.