High Gleason score predicts poor pathologic outcome after neoadjuvant androgen deprivation for locally advanced prostate cancer
Srougi, Miguel [UNIFESP]
Kauffmann, José Roberto[UNIFESP]
Nesrallah, Adriano [UNIFESP]
Leite, Kátia Ramos Moreira [UNIFESP]
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Patients with locally advanced prostate cancer are at high risk for having extraprostatic disease and adverse outcome after radical prostatectomy, which makes neoadjuvant androgen deprivation (NAD) an attractive option, In the present study, we tried to identify predictors of favorable pathologic outcome that will optimize patient selection for this therapeutic approach. Sixty-one patients with locally advanced prostate cancer were enrolled in a Phase II protocol involving 4 months of NAD followed by radical prostatectomy, Flutamide (250 mg orally three times per day for 20 days) and a luteinizing hormone-releasing (LHRH) analog (goserelin 3.6 mg or triptorelin 3.75 mg parenterally monthly) were given to the patients, and 59 of them completed the protocol, The main reason for recruitment was Stage T-3 disease (39 cases), serum prostate specific antigen (PSA) >30 ng/mL (12 cases), poorly differentiated tumors (2 cases), and 100% positive biopsy cores (6 cases). Favorable pathologic outcome was defined as a specimen-confined tumor (negative margins, absence of seminal vesicle/iliac lymph nodes involvement). Initial or pretreatment serum PSA, post-treatment serum PSA, initial clinical stage, and the percentage of positive biopsy cores could not predict the pathologic outcome after NAD, On the other hand, 66% of low-grade tumors (Gleason score less than or equal to 6) and only 8% of high-grade tumors (Gleason score greater than or equal to 7 or any grade 4 component) showed a favorable pathologic outcome. This difference was statistically significant (P = 0.0003), Patients with locally advanced prostate cancer and poorly differentiated tumors only rarely show a favorable pathologic outcome after NAD, For this subset of patients, NAD prior to radical prostatectomy should not be offered with the aim of improving disease outcome.
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