Effects of 3 Months' Neoadjuvant Hormonal Treatment with a GnRH Analogue (Triptorelin) prior to Radical Retropubic Prostatectomy on Prostate-Specific Antigen and Tumour Volume in Prostate Cancer

The Risk of Malignancy in the Surgical Margin at Radical Prostatectomy Reduced Almost Three-Fold in Patients Given Neo-Adjuvant Hormone Treatment

“…In the present study, a prostate volume reduction of 42% was recorded, which is in accordance with figures reported from previous studies [10,14,18,19]. As on average the tumour volume constitutes only about 10% of the total prostate volume, most of this volume reduction in fact represents an effect on the benign part of the gland [20],…”

“…However, indirect evidence suggests that in about one third of hormone treatment patients a true tumour volume reduction actually occurs. In this cat egory of patients, some manifest a tremendous tumour volume reduction, and on average the tumour volume was only 18% of the expected [20], In the present study, there was a significantly lower frequency of positive mar gins in the pretreated group (23 vs. 41 %, p = 0.013). These results are in accordance with findings in a previous study, where 36% of the patients responded to hormone treatment with tumour volume reduction.…”

“…This derived no support from the present study, where no difference was found in serum PSA concentrations after 3 months' hor mone treatment between margin-negative and margin positive patients. However, in previous studies by our group, patients with pronounced tumour volume reduc tion were found to manifest the greatest reductions in PSA [20], These contradictory results may be explained by the fact that the serum PSA concentration after hor mone treatment is an unreliable tumour volume marker and does not reflect local tumour extension [20], The decrease in PSA probably mostly reflects an altered PSA metabolism.…”

“…This is surpris ing as the serum PSA concentration is related to the tumour volume and local tumour extension (pT stage). It is also known that well-differentiated tumours express more PSA per tumour volume compared with poorly dif ferentiated tumours [20], As well-differentiated tumours are also more sensitive to hormone treatment, this may indicate that some well-differentiated tumours with high PSA responded very well to hormonal pretreatment. Fur thermore, of patients with poorly differentiated tumours, probably only those with rather low PSA are suitable for radical treatment (due to T and N stages), while of those with well-differentiated tumours some with high PSA may also be included.…”