ABSTRACT
OBJECTIVES: Stage pT0 following prolonged neoadjuvant endocrine therapy (PPNET) of prostate cancer is of great clinical interest, because this finding suggests maximum tumor damage. Therefore pT0 patients are expected to have an extremely favorable PSA progression rate. The purpose of this study was to assess whether the PSA progression rate of pT0 patients after PPNET is lower than that of non-pT0 patients after PPNET. METHODS: 174 patients with previously untreated, clinical stage cT1-3 carcinomas were submitted to PSA monitored complete androgen deprivation therapy followed by radical prostatectomy (RP). In 138 patients the RP specimens showed residual cancer, in 36 patients no residual cancer was found. Biochemical progression was defined as PSA >/=0.2ng/ml. To control for confounding prognostic factors (Gleason score, cT-stage) between both groups a matched-pair analysis for the cumulative risk of biochemical failure was performed, resulting in 30 matched pairs. RESULTS: With a median follow-up of 37.9 and 46.0 months in the matched non-pT0 and pT0 cohort respectively, matched-pair analysis failed to demonstrate significant differences in crude PSA relapse-free survival between both groups (p=0.7758). CONCLUSION: The results suggest that patients converted into pT0 after PPNET do not represent a subgroup with an extremely favorable prognosis. However our results have to be confirmed by the assessment of larger cohorts of pT0 patients with a longer follow-up. The presented data do not allow drawing any conclusions on the prognostic impact of PPNET in general.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Anilides/administration & dosage , Disease-Free Survival , Flutamide/administration & dosage , Follow-Up Studies , Goserelin/administration & dosage , Humans , Leuprolide/administration & dosage , Male , Matched-Pair Analysis , Neoplasm Staging , Nitriles , Prognosis , Prostate-Specific Antigen/blood , Prostatectomy , Prostatic Neoplasms/blood , Prostatic Neoplasms/surgery , Time Factors , Tosyl CompoundsABSTRACT
OBJECTIVES: To test the hypothesis that in patients with Stage pT0 after prolonged prostate-specific antigen (PSA)-monitored neoadjuvant endocrine therapy, biochemical relapse is extremely rare and derives from systemic tumor recurrence. METHODS: A total of 227 patients with Stage cT1-3 carcinoma underwent PSA-monitored prolonged neoadjuvant endocrine treatment followed by radical prostatectomy. In all pT0 patients, PSA follow-up data were obtained. Patients with a PSA relapse (0.2 ng/mL or greater) underwent biopsy from the vesicourethral anastomosis, and some underwent radiotherapy. RESULTS: Stage pT0 was diagnosed in 38 (16.7%) of 227 patients. The pT0 rate in those with cT1, cT2, and cT3 cancer was 28.2% (11 of 39), 26.3% (20 of 76), and 6.25% (7 of 112), respectively. In Gleason score 2 to 4, 5 to 6, and 7 to 10 carcinoma, the pT0 rate was 50% (3 of 6), 28.4% (25 of 88), and 7.1% (9 of 126), respectively. The median follow-up was 47.0 months (range 20 to 180). PSA relapse was seen in 7 (18.4%) of 38 patients. PSA relapse derived from local tumor relapse in 2 cases, local and systemic tumor relapse in 1 case, and local benign prostate glands in 2 cases. In 2 cases, the nature of the PSA relapse remained unknown. CONCLUSIONS: Mainly clinically organ-confined, low and intermediate-grade tumors were converted to Stage pT0. Local PSA relapse was surprisingly frequent. In part, its malignant nature was confirmed histologically. However, the finding of residual benign prostate glands shows that PSA relapse does not always correspond with tumor relapse. Whether the prognosis in pT0 patients is significantly improved compared with nonpretreated patients cannot be answered on the basis of our data. Nevertheless, the presented results were disappointing.
