917
document
Effect of total androgen ablation on pathologic stage and resection limit status of prostate cancer . Initial results of the Italian PROSIT study . The likelihood of finding organ-confined untreated prostate cancer ( PCa ) by pathological examination at the time of radical prostatectomy ( RP ) is only 50 % in patients with clinically organ-confined disease . In addition , tumour is present at the resection margin in approximately 30 % of clinical T2 ( clinical stage B ) cases . The issue of clinical " understaging " and of resection limit positivity have led to the development of novel management practices , including " neoadjuvant " hormonal therapy ( NHT ) . The optimal duration of NHT is unknown . We undertook the present analysis to evaluate the effect of NHT on pathologic stage of PCa and resection limit status in patients with prostate cancer and treated with total androgen ablation either for three or six months before RP . Between January 1996 and February 1998 , 259 men with prostate cancer underwent radical retropubic prostatectomy and bilateral pelvic node dissection in the 26 centres participating in the Italian randomised prospective PROSIT study . Whole mount sectioning of the complete RP specimens was adopted in each centre for accurately evaluating the pathologic stage and resection limit status . By February 1998 , haematoxylin and eosin stained sections from 155 RP specimens had been received and evaluated by the reviewing pathologist ( RM ) . 64 cases had not been treated with total androgen ablation ( e.g . NHT ) before RP was performed , whereas 58 and 33 had been treated for three and six months , respectively . 114 patients were clinical stage B whereas 41 were clinical stage C. After three months of total androgen ablation , pathological stage B was more prevalent among patients with clinical B tumours , compared with untreated patients ( 57 % in treated patients vs. 36 % in untreated ) . The percentage of cancers with negative margins was statistically significantly greater in patients treated with neoadjuvant therapy than those treated with immediate surgery alone ( 69 % vs. 42 % , respectively ) . After six months of NHT therapy the proportion of patients with pathological stage B ( 67 % vs. 36 % , respectively ) and negative margins was greater than after 3 months ( 92 % vs. 42 % , respectively ) . For clinical C tumours , the prevalence of pathological stage B and negative margins in the patients treated for either 3 or 6 months was not as high as in the clinical B tumours , when compared with the untreated group ( pathological stage B : 31 % and 33 % vs. 6 % in the clinical C cases , respectively . Negative margins : 56 % and 67 % vs. 31 % , respectively ) . The initial results of this study suggest that total androgen ablation before RP is beneficial in men with clinical stage B because of the significant pathological downstaging and decrease in the number of positive margins in the RP specimens . These two effects are more pronounced after six months of NHT than after three months of therapy . The same degree of beneficial effects are not observed in clinical C tumours .
918
Intervention_Pharmacological
total androgen ablation
919
Intervention_Surgical
radical prostatectomy ( RP )
920
Intervention_Pharmacological
" neoadjuvant " hormonal therapy ( NHT )
921
Intervention_Pharmacological
total androgen ablation
922
Intervention_Surgical
radical retropubic prostatectomy and bilateral pelvic node dissection
923
Intervention_Pharmacological
total androgen ablation
924
Intervention_Pharmacological
NHT
925
Intervention_Pharmacological
total androgen ablation
926
Intervention_Pharmacological
neoadjuvant therapy
927
Intervention_Pharmacological
immediate surgery alone
928
Intervention_Pharmacological
total androgen ablation before
929
Intervention_Physical
RP
930
Intervention_Pharmacological
NHT
931
Outcome_Physical
pathologic stage and resection limit status of prostate cancer
932
Outcome_Physical
effect of NHT on pathologic stage of PCa and resection limit status
933
Outcome_Physical
pathologic stage and resection limit status
934
Outcome_Physical
pathological stage B
935
Outcome_Physical
percentage of cancers with negative margins
936
Outcome_Physical
proportion of patients with pathological stage B
937
Outcome_Physical
negative margins
938
Outcome_Physical
pathological stage B and negative margins
939
Outcome_Physical
pathological downstaging
940
Outcome_Physical
positive margins in the RP specimens
941
Outcome_Other
beneficial effects
942
Participant_Condition
prostate cancer