Gary Grossfeld, MD

Androgen deprivation has been used prior to radical prostatectomy in an attempt to improve local control of prostate cancer and delay time to cancer progression. Thirty men (mean age of 65) with clinical stage T3 adenocarcinoma of the prostate were entered into a phase II trial at the University of California, San Francisco, examining the effects of neoadjuvant androgen deprivation (luteinizing hormone-releasing agonist and an antiandrogen) before radical prostatectomy. Twenty-six of these patients subsequently underwent radical prostatectomy. Despite impressive physiological changes in prostate and tumor volume, stage reduction was noted in only 4 patients (15%). Overall, with a mean follow-up of 32.7 months, 72% of patients had evidence of disease recurrence, including detectable PSA. Several series suggest that in patients with stage T1 and T2 disease, the likelihood of a positive surgical margin after radical prostatectomy is decreased substantially by neoadjuvant deprivation. The effect on long-term disease-free survival, however, is still unknown. [Oncol News Int 6(Suppl 3):16-17, 1997