350 Radical prostatectomy with long neoadjuvant hormonal therapy can be effective for high-risk localized prostate cancer patients

350 - Radical prostatectomy with long neoadjuvant hormonal therapy can be effective for ... Page 1 of 1

e350 Radical prostatectomy with long neoadjuvant hormonal therapy can be effective for high-risk localized prostate cancer patients Kato M.1, Tsuzuki T.2, Hattori R.1, Gotoh M.1 1Nagoya

Graduate School of Medicine, Dept. of Urology, Nagoya, Japan, 2Nagoya Daini Red Cross Hospital, Dept. of Pathology, Nagoya, Japan INTRODUCTION & OBJECTIVES: Neoadjuvant hormonal therapy (NHT) for prostate cancer has mainly been reported to reduce the positive surgical margin but not to change outcome. Negative NHT data, other than the adverse effects of hormonal therapy, is, at least, limited. On the other hand, few papers have suggested that NHT could be effective for localized progressive prostate cancer. There have also been rare reports of NHT to target only high-risk prostate cancer. In this paper, we analyzed the results of radical prostatectomy (RP) for highrisk prostate cancer with long (12 months) NHT and identified the possible indication of RP in high-risk patients. MATERIAL & METHODS: Between 2000 and 2010, a total of 296 patients with untreated clinically localized high-risk prostate cancer entered our radical prostatectomy program. Highrisk disease was defined according to the National Comprehensive Cancer Network guideline. Patients were divided by period of NHT and a number of risk factors: Gleason score (GS)(8≦), initial(i) PSA(20≦), and clinical(c) T stage(T3a≦). Biochemical recurrence (BCR)-free probability was estimated using Kaplan-Meier methods and compared using the log-rank test. PSA failure was defined as any detectable PSA level higher than 0.2ng/ml. Intraductal carcinoma of the prostate (IDCP) was checked by one pathologist this time and added to the analysis. PSA re-rise was defined as a consecutive two-time rise of PSA during NHT treatment. RESULTS: Patient mean age was 68 years and iPSA was 22 ng/ml (range 3.5 to 276). Baseline characteristics included clinical stage T1C, T2, or T3 in 33%, 45%, and 21%, and GS7 or less, 8, 9, and 10 in 33%, 37%, 28%, and 2% of patients, respectively. Follow up period was 50 months on average. Improvement of survival was accompanied with reduction of risk factors in all patients (P<0.01). When patients were divided into two groups by 6 month duration of NHT, BCR-free survival significantly improved with only one risk factor of longer NHT (P=0.03). With an increase of risk factor, this significant difference decreased. When a patient had only one risk factor with component of GS5, the effectiveness of NHT disappeared (P=0.03). Furthermore, PSA re-rise during NHT treatment, PSA decline to a lower than detectable level, and positive rate of prostate biopsy became significant prognostic factors in addition to the 3 factors of iPSA, GS and cT stage when preoperative factors were analyzed. All cases with PSA re-rise during NHT showed IDCP positive in the prostate biopsy samples. CONCLUSIONS: RP for patients with high-risk localized prostate cancer with long NHT significantly improved BCR-free survival when there is only one risk factor. In cases with one risk factor of GS, prognosis is better without the component of GS5. Most patients with IDCP positive showed hormone refractory during NHT, therefore RP with long NHT should be avoided in these cases.

file://F:\RamShankar\April\04-05-12\Cip\Sour\350.html

4/6/2012