Adjuvant treatment to surgery

positive lymph nodes after neoadjuvant hormone suppression compared with immediate RP. However, this approach fell into disuse because several randomized clinical trials were unable to detect a difference in the rate of ultimate PSA relapse. The apparent discrepancy between the improvement in pathological variables associated with poor prognosis and biological outcome was probably related to the difficulty of accurately evaluating pathological specimens after hormone therapy. These observations were made after 3 months of CAB neoadjuvant to surgery, and they were repeated with longer neoadjuvant CAB of 8 months [1‐4]. Neoadjuvant hormone treatment before RP cannot as yet be considered a standard of care. Neoadjuvant cytotoxic chemotherapy has been investigated with increasing interest since positive results were achieved with docetaxel in hormone-resistant prostate cancer. Two studies were published [5,6]; one investigated docetaxel and dexamethasone with or without estramustine neoadjuvant to RP, in five cycles of 3 weeks. None of the RP resections showed a pathological complete response, and the main side-effect was a risk of deep venous thrombosis probably related to the estramustine phosphate [5]. Another study using a combination of docetaxel and dexamethasone from 6 weeks to 6 months documented a reduction in PSA level (34% 2 months after treatment [6] and 50% after 3 weeks [5]) with a 25% median reduction in prostate volume. However, again no pathological complete response was documented [5,6]. Surgery does not appear to have been easier or more difficult than usual. Neoadjuvant CAB with or without docetaxel is being studied in phase II protocols. Until the results are available, neoadjuvant cytotoxic chemotherapy with or without hormone suppression must not be used outside carefully designed randomized clinical trials.