A review with referencesNeoadjuvant hormonal therapy (NHT) prior to radical prostatectomy significantly improved the rate of organ-confined disease and cancer-pos. surgical margins in Phase III clin. trials.Whether these pathol. alterations translate into improved disease-free survival is not clear pending long-term follow-up of these patients.The purpose of this report is to evaluate whether patients with organ-confined tumors and neg. surgical margins after NHT have recurrence patterns similar to those in patients not receiving NHT.Consecutive patients (N = 295) receiving NHT prior to radical prostatectomy and 808 consecutive patients undergoing radical prostatectomy alone were studied from a database at Memorial Sloan-Kettering Cancer Center (MSKCC).Fischer's exact test was used for classification variables (clin. stage, biopsy grade, and the use of NHT) and the Student's t-test was used for continuous variables (eg., log serum PSA) in determining the statistical significance in predicting the final pathol. stage (organ confined vs extracapsular and neg. pos. surgical margins).Logistic regression anal. was used to evaluate the impact of serum PSA, clin. stage (T1/T2a vs T2b/T2c), biopsy tumor grade, and NHT on final pathol. stage and margin status.The probability of freedom from PSA relapse was estimated using the Kaplan-Meier method for all patients as well as subgroups based on initial PSA and final pathol. findings.The log-rank test was used for comparison of treatment outcome.A Cox proportionate hazards regression anal. was then performed in order to determine whether these prognostic variables in combination were predictive of earlier biochem. (PSA) failure.Overall, patients receiving NHT had more advanced clin. stage, higher pretreatment PSA, and a higher percentage of poorly differentiated tumors than patients undergoing radical prostatectomy alone.On univariate anal. variables associated with organ confined tumors were: the initial serum PSA (p = 0.0001), pretreatment biopsy grade (WD/MD vs PD,p < 0.0001), T-stage (T1/T2a vs T2b/T2c,p < 0.0001), and whether the patient received NHT (p = 0.01).The most significant factors associated with neg. surgical margins was the administration of NHT (p < 0001) and the initial serum PSA (ng/mL) (p = 0.01).The multivariate anal. confirmed that pretreatment with NHT (p = 0.001), the initial serum PSA (p = 0.0001) clin. T1/T2a tumors (0.0001) and well differentiated tumors on biopsy (WD vs MD, p = 0.003; WD vs PD, p = 0.001) favorably impacted on the incidence of pathol. organ confined disease.Only pretreatment with NHT (p = 0.0001) and the initial PSA (p = 0.002) were associated with obtaining cancer-free surgical margins.Comparison of time until biochem. (PSA) recurrence was not significantly different between patients treated with or without NHT.Subgroup anal. confirmed that those patients with organ confined tumors and neg. surgical margins following treatment with NHT had similar patterns of PSA recurrence as patients not treated with NHT.For patients with extracapsular tumors or pos. surgical margins there was an insignificant trend towards earlier recurrence after NHT.This appears to result from the large selection bias towards higher risk patients treated with NHT at MSKCC.
