Neoadjuvant XXXX blockade prior to prostatectomy: a retrospective study and critical review.

@entity1 @entity263 @entity5 @entity190 @entity11179 @entity342
The treatment of locally advanced @entity263 is controversial, as there are several possible treatment options. The aims of temporary @entity342 deprivation prior to radical prostatectomy are to achieve downgrading and downstaging of the @entity5 , an increase in local control, a decrease in morbidity and operative sequelae, a decrease in the time to progression, and an improvement in survival. A retrospective study has been carried out on 100 @entity1 who underwent radical prostatectomy between 1988 and 1992. Forty @entity1 received @entity342 deprivation therapy followed by prostatectomy, while the remaining 60 acted as controls, undergoing prostatectomy alone. Treated @entity1 had a 40-50% reduction in prostate volume after 3 months, facilitating dissection of the prostate, reducing intraoperative @entity190 , and reducing operation time. Of these 40 treated @entity1 , one third showed clinical downstaging; one @entity1 staged initially as T2/B was downstaged to PT0. The proportion of @entity1 with positive surgical margins was 32% in the group treated preoperatively, compared with 57% in untreated @entity1 . Treated @entity1 also recovered full continence more rapidly after the operation than @entity1 who underwent prostatectomy alone. After @entity342 blockade, serum @entity11179 levels returned to normal (< 4 ng/ml) in 37 of the 40 @entity1 . Of these @entity1 , 22 had undetectable serum @entity11179 levels (< 0.25 ng/ml), showing a definite reduction in @entity5 activity. @entity11179 levels after 3 months of neoadjuvant hormonal treatment might play a useful predictive role in selecting @entity1 before radical prostatectomy, since 86% with undetectable @entity11179 had @entity5 confined to the gland (T2/B2), while @entity1 who still had @entity11179 > 4 ng/ml all had stage T3-T4 @entity5 . Although downstaging was confirmed pathologically in only 13% of @entity1 , this is of significance when the total number of @entity1 with locally advanced @entity263 is considered and, therefore, may have implications for survival in the future. Prospective randomized studies should provide conclusive information on the potential benefit of this approach.
