BACKGROUND: Routine use of neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP) is not recommended, but it is sometimes performed to reduce the prostate size and tumor volume or to prevent tumor progression during the wait times for surgery in clinical practice. On the other hand, the impact of NHT on the pattern of biochemical recurrence (BCR) is unknown. METHODS: We retrospectively examined 1749 consecutive patients who underwent RP between 1996 and 2017. Among the patients who met the inclusion criteria, BCR developed in 240 of non-NHT patients and in 120 of NHT patients during the mean follow-up period of 6.9 years. We examined the impact of NHT on the PSA-doubling time (DT) following BCR at different times after RP. RESULTS: The median PSA-DTs in non-NHT patients who experienced BCR in the first year after surgery, between 1 and 2 years, between 2 and 3 years, between 3 and 4 years, between 4 and 5 years, and at > 5 years were 5.5, 8.8, 11.3, 17.7, 18.2, and 18.4 months, respectively. On the other hand, those in NHT patients were 1.4, 4.1, 9.1, 13.4, 27.2, and 19.3 months, respectively. The differences of PSA-DTs in the first year after surgery (p < 0.001) and between 1 and 2 years (p = 0.005) were significant between non-NHT and NHT patients. CONCLUSION: Patients who received NHT had a higher risk of a rapid PSA increase when they experienced BCR, especially within 2 years after RP. In order to not miss the optimal timing of salvage treatment for BCR, intensive PSA follow-up is necessary.
BACKGROUND: Routine use of neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP) is not recommended, but it is sometimes performed to reduce the prostate size and tumor volume or to prevent tumor progression during the wait times for surgery in clinical practice. On the other hand, the impact of NHT on the pattern of biochemical recurrence (BCR) is unknown. METHODS: We retrospectively examined 1749 consecutive patients who underwent RP between 1996 and 2017. Among the patients who met the inclusion criteria, BCR developed in 240 of non-NHT patients and in 120 of NHT patients during the mean follow-up period of 6.9 years. We examined the impact of NHT on the PSA-doubling time (DT) following BCR at different times after RP. RESULTS: The median PSA-DTs in non-NHT patients who experienced BCR in the first year after surgery, between 1 and 2 years, between 2 and 3 years, between 3 and 4 years, between 4 and 5 years, and at > 5 years were 5.5, 8.8, 11.3, 17.7, 18.2, and 18.4 months, respectively. On the other hand, those in NHT patients were 1.4, 4.1, 9.1, 13.4, 27.2, and 19.3 months, respectively. The differences of PSA-DTs in the first year after surgery (p < 0.001) and between 1 and 2 years (p = 0.005) were significant between non-NHT and NHT patients. CONCLUSION:Patients who received NHT had a higher risk of a rapid PSA increase when they experienced BCR, especially within 2 years after RP. In order to not miss the optimal timing of salvage treatment for BCR, intensive PSA follow-up is necessary.
Authors: Zafer Tandogdu; Justin Collins; Greg Shaw; Jennifer Rohn; Bela Koves; Ashwin Sachdeva; Ahmed Ghazi; Alexander Haese; Alex Mottrie; Anup Kumar; Ananthakrishnan Sivaraman; Ashutosh Tewari; Benjamin Challacombe; Bernardo Rocco; Camilo Giedelman; Christian Wagner; Craig G Rogers; Declan G Murphy; Dmitry Pushkar; Gabriel Ogaya-Pinies; James Porter; Kulthe Ramesh Seetharam; Markus Graefen; Marcelo A Orvieto; Marcio Covas Moschovas; Oscar Schatloff; Peter Wiklund; Rafael Coelho; Rair Valero; Theo M de Reijke; Thomas Ahlering; Travis Rogers; Henk G van der Poel; Vipul Patel; Walter Artibani; Florian Wagenlehner; Kris Maes; Koon H Rha; Senthil Nathan; Truls Erik Bjerklund Johansen; Peter Hawkey; John Kelly Journal: BJU Int Date: 2021-03-10 Impact factor: 5.588