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ORIGINAL ARTICLE |
1 Institute of Urology, University of Pisa, I-56126 Pisa, Italy
2 Institute of Pathology, University of Ancona, I-60020 Ancona, Italy
3 Division of Urology, Ospedale di Circolo e Fondazione Macchi, I-21100 Varese, Italy
4 Institute of Urology, University of Padova, I-35128 Padova, Italy
5 Division of Urology, I-33100 Udine, Italy
6 Division of Urology, I-53100 Siena, Italy
7 Institute of Urology, University of Bari, I-70124 Bari, Italy
8 Division of Urology, I-22100 Como, Italy
9 Division of Urology, I-30026 Portogruaro, Venezia, Italy
10 Division of Urology, I-32100 Belluno, Italy
11 Division of Urology, I-24100 Bergamo, Italy
12 Institute of Urology, University of Brescia, I-25123 Brescia, Italy
13 Division of Urology, San Secondo Parmense, I-46036 Parma, Italy
14 Division of Urology, San Giovanni Bosco Hospital, I-10154 Torino, Italy
Correspondence to:
Professor C Selli, Urologia Universitaria, Dipartimento di Chirurgia, Via Roma 67, I-56126 Pisa, Italy;
c.selli{at}dc.med.unipi.it
Aims: To compare the pathological stage and surgical margin status in patients undergoing either immediate radical prostatectomy or 12 and 24 weeks of neoadjuvant hormonal treatment (NHT) in a prospective, randomised study.
Methods: Whole mount sections of 393 radical prostatectomy specimens were evaluated: 128 patients had immediate surgery, 143 were treated for 12 weeks and 122 for 24 weeks with complete androgen blockade.
Results: Histopathology revealed organ confined tumours in 40.4% of patients with clinical stage B disease in the immediate surgery group, whereas 12 and 24 weeks of NHT increased the number of organ confined tumours to 54.6% and 64.8%, respectively. Among patients with clinical stage C tumours, pathological staging found organ confined disease in 10.4%, 31.4%, and 61.2% in the immediate surgery, 12 weeks of NHT, and 24 weeks of NHT groups, respectively. Preoperative NHT caused a significant decrease in positive margins both in patients with clinical stage B and C disease. The extent of margin involvement was not influenced by preoperative treatment.
Conclusions: Neoadjuvant androgenic suppression is effective in reducing both the pathological stage and the positive margin rate in patients with stage B and C prostatic cancer undergoing radical surgery. Some beneficial effects are evident in those patients treated for 24 weeks, and it is reasonable to assume that the optimal duration of NHT is longer than three months.
Keywords: prostate neoplasm; hormonal treatment; radical prostatectomy; histopathology
Abbreviations: NHT, neoadjuvant hormonal treatment; PSA, prostate specific antigen; RP, radical prostectomy
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