@entity342 deprivation prior to radical prostatectomy for T2b and T3 XXXX .

@entity1 @entity263 @entity5 @entity342 @entity1486
OBJECTIVE: In an effort to improve on the results of radical prostatectomy for clinical stages T2b and T3 @entity263 , a selected group of @entity1 received @entity342 deprivation for three to sixteen months prior to surgery. METHODS: Fifteen @entity1 with clinical T2b and 22 with small T3 @entity5 received a luteinizing hormone-releasing hormone analog (n = 34) or a bilateral orchiectomy (n = 3) three to sixteen months prior to radical retropubic prostatectomy. The prostate was evaluated with particular attention to @entity5 grade, presence of extracapsular extension, @entity5 at the inked margin, seminal vesicle invasion, and @entity5 in the lymph nodes. RESULTS: No @entity1 had clinical or chemical ( @entity1486 [PSA]) progression during @entity342 deprivation. The PSA level declined a mean 90 percent and remained above 4 ng/mL in only two @entity1 . The prostate volume decreased an estimated 30-50 percent. @entity263 at the inked margin was found in 15 (41%) and seminal vesicle involvement in 11 (30%) @entity1 . Five (14%) had @entity5 in regional lymph nodes. There was no difference in regard to positive margins or lymph node metastases between those clinically staged as T2b and those preoperatively staged as T3. Fourteen @entity1 have received adjuvant therapy (13 @entity342 deprivation, one radiation therapy). None has progressed (mean follow-up, 38.4 months). Of 23 who did not receive immediate additional therapy, six (26%) had progression, as was evident from an increase in PSA and have since been treated. Only one continued to progress. Thirty-five of the 37 @entity1 are alive. Seventeen (46%) are @entity5 free (PSA < 0.4 ng/mL) without further @entity342 deprivation. CONCLUSIONS: Only a prospective randomized trial can determine whether @entity342 deprivation prior to radical prostatectomy has a role. The results from this trial are encouraging for several reasons. The prostate is much smaller as a result of @entity342 deprivation and this may facilitate surgery. Although the great majority of these @entity1 were expected to be margin positive, 60 percent had negative margins and only 14 percent had positive lymph nodes.
