Introduction and Objectives
NHT is being applied in patients scheduled for operative treatment of prostate cancer due to reported by some authors potential; advantages as decrease of the size of the tumor and prostate facilitating surgery, rarer positive surgical margins, possibility to postpone surgery and reduction of cancer cells spread into blood vessels. Nevertheless, NHT nowadays is not recommended by EAU (class A recommendation) due to lack of evidence of long term benefit, high costs of therapy, possibility of histological assessment alteration and suppression of PSA levels which makes this factor useless in post surgical evaluation of the patient. Objectives: The authors asses the influence of NHT on histopatological findings in prostate comparing specimens from TRUScoreBx and after radical prostatectomy.
Material and Methods
We retrospectively analyzed 215 radical prostatectomies performed in two reference centers (1, n = 84 and 2, n = 131) in the period 2007–2008. Only patients who had TURScoreBx and radical prostatectomy performed in the same center were included (n = 117; centre 1, n = 44, centre 2, n = 73). In the centre 1, all patients after TRUScoreBx received NHT (n = 44). The LH-RH analog and antiandrogens were used. We compared both groups with respect to age, PSA levels, Gleason grading of biopsy specimens, timing of surgery after first diagnosis, Gleason score and staging (pT) after radical prostatectomy.
We found no significant difference in age and PSA levels in both groups in the moment in first diagnosis of prostate cancer. There were no significant difference in Gleason score of TRUScoreBx in both groups. Timing of surgery was similar, medien 73 days (18–568) in NHT group and median 65 days (27–331) in non-NHT group. The number of Gleason score <7 in NHT group was significantly lower than in non-NHT group (72.73% vs 90.41%). We found in post prostatectomy specimens pT3 stage in 41 (40.17%) cases and in this group we found significant difference between NHT and non-NHT group (pT3 11.36% in NHT group vs pT3 49.32% in non-NHT group).
The Neoadiuvant Hormonal Therapy applied after TRUSscoreBx results in higher Gleason score and lower staging of the tumor in post radical prostatectomy specimens. Long NHT causes fibrosis and atrophy of gland epithelium.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.