NEOADJUVANT ENDOCRINE THERAPY PRIOR TO NERVE-SPARING RADICAL PROSTATECTOMY IN PATIENTS WITH STAGE T2 PROSTATIC CANCER

Radical prostatectomy is the effective treatment for clinical T2 prostatic cancer. However, clinical T2 stage is often understaged preoperatively. The objective of neoadjuvant therapy is to increase the curability of surgery to understaged patients. The present study was based on patients who had had neoadjuvant endocrine therapy (LH-RH agonist) prior to radical nerve-sparing prostatectomy for T2 prostatic cancer. Sexual function were estimated before and after surgery.<br>Ten patients with a mean age of 64.6 years (range 57-71 years) and biopsy-proven cancer received this treatment modality. No patients had evidence of lymph node metastasis by the pelvic computerized tomography and their bone scan was negative for metastasis.<br>Clinical stage was T2a in 3 patients and T2b in 7. The grade of these tumors as assessed on prostatic biopsy before neoadjuvant endocrine treatment was well differentiated in 3 and moderately differentiated in 7.<br>The duration of neoadjuvant endocrine therapy was 3.6 months (range 2-5 months) in average. Serum levels of prostatic specific antigen (PSA) were examinated monthly and prostate volume was measured by transrectal ultrasonography before and after neoadjuvant treatment. Decrease in serum PSA values was observed from an average level of 8.6ng/ml (range 3.1-17.5ng/ml) determined prior to neoadjuvant treatment to an average of 1.1ng/ml (range 0.6-3.3ng/ml) determined after neoadjuvant treatment.<br>An average reduction of prostatic volume was 25.3% (range 7.4-56.7%) after neoadjuvant therapy. Pathological effects of the neoadjuvant therapy by the criteria proposed by Japanese Urological Association were Grade (G) 0a in 3 patients, G0b in 4, G1 in 2 and G2 in 1. Of patients who had 10 stage T2 cancer before treatment, 4 had pT2 and 6 pT3. Of six patients who had pT3 cancer, 5 had capsular invasion, 2 positive surgical margins, 2 seminal vescicle invasion and one positive lymph node.<br>Data of the sexual function before (all cases) and after surgery (only pT2b patients) were obtained by a questionnaire regarding 8 questions. All 10 patients were potent preoperatively. Four patients with pT2 cancer did not receive anticancer therapy after surgery. Of the 4 patients, two patients were able to have sexual intercourse and one could obtain penile erection. One patient with pT3 relapsed after seven months, but the other nine patients were alive without disease.