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Hormone therapy prior to radical prostatectomy in patients with clinical stage C prostate cancer
Author(s) -
Voges Gunther E.,
Mottrie Alexandre M.,
Stöckle Michael,
Müller Stephan C.
Publication year - 1994
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.2990250704
Subject(s) - medicine , flutamide , urology , prostate cancer , antiandrogen , prostate , radical retropubic prostatectomy , prostatectomy , stage (stratigraphy) , goserelin , metastasis , hormonal therapy , prostate specific antigen , cancer , gynecology , paleontology , androgen receptor , biology
Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin‐releasing hormone analog, goserelin acetate (Zoladex®; Zeneca Pharmaceuticals, Macclesfield, UK) plus an antiandrogen (flutamide). Based on digital rectal examination (DRE), reductions of the size of the prostate and the tumor were noted in 91.4% of patients. Ultrasound demonstrated a decrease in prostatic volume between 0% and 62.5% (median 31%). Prostate‐specific antigen (PSA) levels (Hybritech®) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prostatectomy. Pathologically, only 9 patients (14.1%) had organ‐confined disease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had positive lymph nodes (stage D1). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Maximal androgen blockade for a period of 3 months in clinical stage C prostate cancer induces a notable reduction in prostate size (“downsizing”). A “downstaging” effect, as suggested by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival. © 1994 Wiley‐Liss, Inc.