Korean J Urol.  2011 Jan;52(1):19-23.

Neoadjuvant Hormonal Therapy Preceding Radical Prostatectomy for Clinically Localized Prostate Cancer: Early Postoperative Complications and Biochemical Recurrence

• Yang SW
• Song KH
• Lim JS
• Sul CK

Abstract

PURPOSE
The effect of neoadjuvant hormonal therapy (NHT) on radical retropubic prostatectomy (RRP) for prostate cancer is various and remains a controversy for urologists. We conducted this study to comparatively evaluate whether NHT before RRP is indicated and beneficial in the aspects of postoperative complications, positive surgical margin, and biochemical recurrence.
MATERIALS AND METHODS
Between September 2006 and December 2009, 69 men were scheduled for RRP as a treatment for clinically localized and locally advanced prostate cancer and were divided into two groups. Group 1 (n=31, 44.9%) was treated with RRP only, and group 2 (n=38, 55.1%) underwent RRP with preoperative NHT. We evaluated clinical parameters, surgical parameters, and the positive margin rate in surgical specimens and the biochemical recurrence rate.
RESULTS
There were no statistical differences in age, body mass index (BMI), preoperative biopsy Gleason score, initial serum prostate-specific antigen (PSA) levels, International Prostate Symptom Score (IPSS), or quality of life (QoL) between the two groups (p>0.05). We also observed no differences in the transfusion rate, mean catheterization time, or positive margin rate (p>0.05). However, the mean operative time was significantly higher in the RRP with preoperative NHT group than in the other group (p=0.034). There was no significant difference in the biochemical recurrence rate during the last follow-up according to NHT (p=0.102) or positive surgical margin (p=0.473).
CONCLUSIONS
These results suggest that there were no clinical benefits to the administration of NHT before RRP from the viewpoint of biochemical recurrence.

Keyword

Neoadjuvant therapy; Prostatectomy; Prostatic neoplasms

MeSH Terms

Biopsy
Body Mass Index
Catheterization
Catheters
Follow-Up Studies
Humans
Male
Neoadjuvant Therapy
Neoplasm Grading
Operative Time
Postoperative Complications
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Quality of Life
Recurrence
Prostate-Specific Antigen

Figure

• 

  FIG. 1 Kaplan-Meier curves for prostate-specific antigen (PSA) recurrence free survival until PSA failure according to treatment regimen. Biochemical recurrence rate does not show any significant difference between 2 arms. log-rank test, p=0.102.

Reference

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010. 60:277–300.

2. Jani AB, Hellman S. Early prostate cancer: clinical decision-making. Lancet. 2003. 361:1045–1053.

3. Macfarlane MT, Abi-Aad A, Stein A, Danella J, Belldegrun A, deKernion JB. Neoadjuvant hormonal deprivation in patients with locally advanced prostate cancer. J Urol. 1993. 150:132–134.

4. Paulson DF. Neoadjuvant androgen-deprivation therapy prior to radical prostatectomy: con. Urology. 1996. 48:539–540.

5. Song J, Chang K. Current status of hormonal therapy for prostate cancer in Korea: a national survey of Korean uro-oncologists. Korean J Urol Oncol. 2003. 1:175–180.

6. Sriprasad S, Feneley MR, Thompson PM. History of prostate cancer treatment. Surg Oncol. 2009. 18:185–191.

7. Hurtado-coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative neoadjuvant androgen withdrawal therapy in prostate cancer: the Canadian experience. Urology. 2002. 60:3 Suppl 1. 45–51.

8. Fair WR, Aprikian AG, Cohen D, Sogani P, Reuter V. Use of neoadjuvant androgen deprivation therapy in clinically localized prostate cancer. Clin Invest Med. 1993. 16:516–522.

9. Civantos F, Sadek S, Öbek C, Lai S, Soloway M. Neoadjuvant hormonal therapy prior to radical prostatectomy. Mol Urol. 1999. 3:201–204.

10. Monfette G, Dupont A, Labrie F. Labrie F, editor. Temporary combination therapy with flutamide and tryptex as adjuvant to radical prostatectomy for the treatment of early stage prostate cancer. Early stage prostate cancer: diagnosis and choice of therapy. 1989. New York: Elsevier Science;41–51.

11. Soloway MS, Sharifi R, Wajsman Z, McLeod D, Wood DP Jr, Puras-Baez A. The Lupron Depot Neoadjuvant Prostate Cancer Study Group. Randomized prospective study comparing radical prostatectomy alone versus radical prostatectomy preceded by androgen blockade in clinical stage B2 (T2bNxM0) prostate cancer. J Urol. 1995. 154:424–428.

12. Goldenberg SL, Klotz LH, Srigley J, Jewett MA, Mador D, Fradet Y, et al. Canadian Urologic Oncology Group. Randomized, prospective, controlled study comparing radical prostatectomy alone and neoadjuvant androgen withdrawal in the treatment of localized prostate cancer. J Urol. 1996. 156:873–877.

13. Schulman CC, Debruyne FM, Forster G, Selvaggi FP, Zlotta AR, Witjes WP. European Study Group on Neoadjuvant Treatment of Prostate Cancer. 4-year follow-up results of a European prospective randomized study on neoadjuvant hormonal therapy prior to radical prostatectomy in T2-3 N0M0 prostate cancer. Eur Urol. 2000. 38:706–713.

14. Meyer F, Moore L, Bairati I, Lacombe L, Têtu B, Fradet Y. Neoadjuvant hormonal therapy before radical prostatectomy and risk of prostate specific antigen failure. J Urol. 1999. 162:2024–2028.

15. Gleave ME, Goldenberg SL, Chin JL, Warner J, Saad F, Klotz LH, et al. Randomized comparative study of 3 versus 8-month neoadjuvant hormonal therapy before radical prostatectomy: biochemical and pathological effects. J Urol. 2001. 166:500–506.

16. Pendleton J, Pisters LL, Nakamura K, Anai S, Rosser CJ. Neoadjuvant therapy before radical prostatectomy: Where have we been? Where are we going? Urol Oncol. 2007. 25:11–18.

17. Schulman CC. Neoadjuvant androgen blockade prior to prostatectomy: a retrospective study and critical review. Prostate Suppl. 1994. 5:9–14.

18. Gao X, Zhou T, Tang YJ, Lu X, Sun YH. Neoadjuvant hormonal deprivation for patients undergoing radical prostatectomy. Asian J Androl. 2009. 11:127–130.

19. Pu XY, Wang XH, Wu YL, Wang HP. Comparative study of the impact of 3-versus 8-month neoadjuvant hormonal therapy on outcome of laparoscopic radical prostatectomy. J Cancer Res Clin Oncol. 2007. 133:555–562.

20. Maldonado-Valadez R, Teber D, Erdogru T, Safi KC, Frede T, Rassweiler J. The impact of neoadjuvant hormonal therapy on the outcome of laparoscopic radical prostatectomy: a matched pair analysis. J Urol. 2006. 175:2092–2096.

21. Brown JA, Garlitz C, Strup SE, Hubosky SG, Gomella L. Laparoscopic radical prostatectomy after neoadjuvant hormonal therapy: an apparently safe and effective procedure. J Laparoendosc Adv Surg Tech A. 2004. 14:335–338.

22. Hakimian P, Blute M Jr, Kashanian J, Chan S, Silver D, Shabsigh R. Metabolic and cardiovascular effects of androgen deprivation therapy. BJU Int. 2008. 102:1509–1514.

23. Nanda A, Chen MH, Braccioforte MH, Moran BJ, D'Amico AV. Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease-induced congestive heart failure or myocardial infarction. JAMA. 2009. 302:866–873.

24. D'Amico AV, Denham JW, Crook J, Chen MH, Goldhaber SZ, Lamb DS, et al. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol. 2007. 25:2420–2425.

25. Keating NL, O'Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006. 24:4448–4456.