Neoadjuvant Hormonal Treatment Prior To Radical Prostatectomy

Radical prostatectomy is widely performed in patients with early, locally confined prostate cancer and may lead to cure of the disease, provided that all malignant cells are removed.1,2 Unfortunately, none of the currently used diagnostic tools are able to reliably identify patients with true locally confined disease. As a result, it has been shown in numerous studies that clinical staging regularly underestimates pathological stage: about 30% of patients with prostate cancer defined as cT1 or cT2 are found to have T3 tumors.3,4 Positive surgical margins can be found in 10-20% of cT1 patients and in 30-60% of cT2 patients, leading to an adverse prognosis.1,5 Given the well-known androgen sensitivity of prostate cancer, neoadjuvant hormonal treatment has been explored as a way to increase the rate of organ-confined disease and ultimately potentially improve disease progression and survival.6 This idea is not new: the first descriptions of using hormonal treatment to shrink the prostate, thus making it more suitable for operative removal, date back to 1941.7 With the availability of reversible luteinizing hormone-releasing hormone (LHRH) analogs and non-steroidal antiandrogens, there is a renewed interest in preoperative endocrine manipulation of prostate cancer in an attempt to improve long-term results.6 However, in contrast to external beam radiation, in which neoadjuvant hormonal treatment seems to have earned its place, the role of neoadjuvant treatment prior to radical prostatectomy remains controversial. For the following we pay tribute to the data of the European Study Group on Neoadjuvant Treatment of Prostate Cancer, as put forward by Schulman etal.,6 and to the recent review of van Poppel.1

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