Objective: Our previously reported non-randomized clinical trial proved the ability of preoperative androgen ablation therapy (AAT) to decrease positive surgical margins and to down stage a subset of biopsy proven stage T3 cancer. This study focuses on progression of disease in this group over a 4-5 year period.
Materials and methods: This study group consisted of 258 consecutive radical prostatectomies that evolved into three groups: 1) 124 patients with clinical stage T2b-c cancer given AAT; 2) 118 patients with clinical stage T2a not given AAT; 3) 16 patients with proven stage T3 by TRUS guided biopsy and given AAT.
Results: Comparison of AAT (n = 140) to no AAT (n = 118) resulted in positive surgical margin rates of 15.3% vs. 49.2%. Specimen confined disease had tumor progression as measured by serum prostate specific antigen of 16.9% (15/89) for AAT (pC.001) vs 10% (5/49) for no AAT (p = 0.288). For known stage T3/C, 43.8% (7/16) downstaged, and 85.7% (6/7) were free of disease at 46.7 mos (mean). The 56.3% with nonconfined (persistent) cancer after AAT had progression usually by one year.
Conclusion: Neoadjuvant androgen ablation therapy before radical prostatectomy decreased by 3-fold the rate of positive surgical margins (+SM). The vast majority of these patients with +SMs were treated with either external beam radiation or AAT. A near two fold increase of specimen confined disease was found in those given AAT (p < .001). However, the rates of progression (16.9% and 10.2% respectively) were greater in the AAT though not statistically significant (p = 0.288).