Hormone-suppressive neoadjuvant therapy in prostate cancer

Since localized adenocarcinoma of the prostate is curable with radical prostatectomy, an important challenge is detection of parameters that allow preoperative separation of localized tumours from those with extraprostatic spread. Nearly 60% of men with clinically localized prostatic cancer actually have intraprostatic disease and are potentially curable; the frequency of positive margins in the surgical specimen following radical prostatectomy is a substantial problem as it implies an increased risk of tumour progression. Attempts to decrease the size of the prostate before radical prostatectomy were first reported in the late 1940s; subsequently, impressive results have been reported following total androgen blockade before radical prostatectomy. Neoadjuvant hormono-suppressive therapy has been part of the therapeutic protocols of the Institute of Urology of Ancona since 1991. We have included in this protocol 52 patients with a histologic diagnosis of adenocarcinoma of the prostate; 18 patients were CT2 N0M0 and 34 patients were CT3N0M0. All the patients underwent a 3-month course of androgen deprivation and then pelvic lymphadenectomy and radical prostatectomy. A down-staging effect was recorded in 7 of the T3N0M0 cases. The evaluation of indices of cellular proliferation allowed us to observe decreased tumoral activity after androgen deprivation.