“Immediate Hormonal Therapy Compared with Observation After Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer”
Edward M. Messing, M.D., Judith Manola, M.S., Michael Sarosdy, M.D., George Wilding, M.D., E. David Crawford, M.D., and Donald Trump, M.D.
In this study 98 patients underwent
prostatectomies and pelvic lymphadenectomies.
All had nodal metastasis,
or cancer spreading to the lymph nodes. At random, patients
were assigned to receive immediate antiandrogen therapy
following surgery. A doctor only observed the remaining
patients. Physicians assessed patients quarterly during
the first year and then semiannually. After 7 years,
7 of 47 patients who had received this therapy died,
compared to 18 of 51 men in the observation group. Specifically,
3 men in the hormone group and 16 in the observation
group died from prostate cancer. Those who were alive
and had no evidence of recurrent disease consisted of
36 patients (77%) who had the hormones after their prostatectomy
and 9 (18%) of patients who chose to observe their outcome
“Neoadjuvant Hormone Therapy Before Salvage Radiotherapy for an Increasing Post-radical Prostatectomy Serum Prostate Specific Antigen Level”
TIGUERT, RABI; RIGAUD, JEROME; LACOMBE, LOUIS; LAVERDIERE, JACQUES; FRADET, YVES Journal of Urology. 170(2, Part 1):447-450, August 2003.
Within this study doctors retrospectively
evaluated 81 patients who were treated with neoadjuvant
deprivation therapy before salvage external
beam radiation treatment due to an increased PSA
level following radical
retropubic prostatectomy. Patients were analyzed
based on the outcome of preoperative, pathological,
postoperative characteristics, pre-salvage treatment,
and radiation therapy. Prior to the salvage radiotherapy
patients received a 3-month injection of a luteinizing
hormone releasing hormone analogue.
Doctors followed up with their patients approximately
38 months after external beam radiation and 91 months
after radical prostatectomy. At 3 years 75% of patients
were free of biochemical failure and 50% were at 5 years.
Two patients (2%) died of prostate cancer. Those who
benefited most from this treatment were patients with
a pre-radiation PSA
level less than 1 and a Gleason
score less than 7.
“Incidence, Etiology, Location, Prevention, and Treatment of Positive Surgical Margins After Radical Prostatectomy for Prostate Cancer”
WIEDER, JEFF A.; SOLOWAY, MARK S. Journal of Urology. 160(2):299-315, August 1998.
In this study researchers reviewed
recent literature regarding data on positive margins
during radical prostatectomy.
Artifacts induced by tissue processing, accidental incising
into the prostate, and/or incising into extraprostatic
tumor may all contribute to positive surgical margins.
Those at higher risk of positive margins include patients
with a PSA of 10 o greater, a Gleason score of 7, multiple
positive biopsies, or stage T2b, T2c, or T3 cancer.
Although neoadjuvant androgen deprivation does not delay
progression or improve survival, it does reduce the
incidence of positive margins.