High failure rate associated with long-term follow-up of neoadjuvant androgen deprivation followed by radical prostatectomy for stage C prostatic cancer.

Abstract

To evaluate whether neoadjuvant androgen deprivation before radical prostatectomy decreases tumour stage in patients with stage C prostatic cancer and to estimate the efficacy of cancer control achieved with this form of treatment. Thirty men (mean age 65 years, range 52-74) with clinical stage C adenocarcinoma of the prostate were included in a phase II trial of neoadjuvant androgen deprivation (luteinizing hormone-releasing hormone agonist and an antiandrogen) before radical prostatectomy. The timing and extent of the changes in serum prostate specific antigen (PSA) levels and both prostate and cancer volume were recorded. Twenty-six men underwent radical prostatectomy with pelvic lymphadenectomy, two had pelvic lymphadenectomy alone, one had pelvic lymphadenectomy with radiotherapy and one refused additional treatment despite significant reductions in tumour volume and PSA while undergoing androgen deprivation. The toxicity of the treatment was low. Significant reductions in prostatic volume (mean 35%), tumour volume (mean 50%) and PSA concentrations (mean 96%) occurred in all patients, with the maximum reductions recorded during the first 2 months of androgen deprivation. However, despite significant physiological changes in prostate and tumour volume, tumour stage was reduced in only four patients. Of the patients who were surgically staged 41% were ultimately identified as having more advanced disease, including lymph node metastases in 21%. Overall, with a mean follow-up of 32.7 months, 72% of patients had evidence of disease recurrence, including detectable PSA. Of 26 patients who underwent radical prostatectomy, local recurrence occurred in five (19%), distant recurrence in one (4%) and both local and distant recurrence in one (4%). This study suggests that tumour stage reduction is uncommon in patients with stage C prostatic cancer treated with neoadjuvant androgen deprivation followed by radical prostatectomy. Furthermore, local and distant recurrences, as well as detectable levels of PSA, are common after such treatment.