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

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.