© 2006 THE AUTHORS JOURNAL COMPILATION © 2 0 0 6 B J U I N T E R N A T I O N A L | 9 9 , 3 11 – 3 1 4 | doi:10.1111/j.1464-410X.2006.06559.x 311 Original Article RESULTS AFTER SURGERY FOR CLINICAL T3a PROSTATE CANCER WITH OR WITH NO NEOADJUVANT ADT HSU et al. Comparing results after surgery in patients with clinical unilateral T3a prostate cancer treated with or without neoadjuvant androgen-deprivation therapy Chao-Yu Hsu, Steven Joniau, Tania Roskams*, Raymond Oyen† and Hein Van Poppel Departments of Urology, *Histopathology and †Radiology, University Hospitals KULeuven, Leuven, Belgium Accepted for publication 16 August 2006 patients were not treated with nADT and 35 were. The Kaplan–Meier method was used to calculate survival rates. RESULTS With no nADT the biochemical progression- free survival (PFS) was 59.5%, the clinical PFS was 95.9%, the cancer-specific survival (CSS) was 98.7%, and overall survival was 95.9% at 5 years. With nADT, the biochemical PFS was 43.4%, clinical PFS was 77.6%, CSS was 88.7%, and overall survival was 79.8% at 5 years. The positive surgical margin rate with no nADT and with nADT was 33.5% and 57.1%, respectively, and the respective mean cancer volume was 6.6 mL and 4.0 mL. CONCLUSION nADT can decrease tumour size but does not reduce the positive surgical margin rate, nor improve the survival rate in unilateral cT3a disease. Because of side-effects and treatment costs, we do not advise nADT in patients with unilateral cT3a prostate cancer. KEYWORDS prostate cancer, cT3, neoadjuvant, androgen- deprivation therapy OBJECTIVE To compare the results in patients with unilateral cT3 prostate cancer treated with or with no neoadjuvant androgen-deprivation therapy (nADT), as nADT might have benefit in cT2 prostate cancer, but for cT3 tumours its use remains controversial, and it is unclear whether it can prevent or delay progression after surgery. PATIENTS AND METHODS Between 1987 and 2004, 235 patients were assessed as having unilateral cT3 disease by a digital rectal examination; before surgery, 200 INTRODUCTION Locally advanced prostate cancer is defined as cancer that has extended clinically beyond the prostatic capsule, with invasion of the pericapsular tissue, apex, bladder neck, or seminal vesicle, but with no lymph node involvement or distant metastases. The treatment of T3 prostate cancer can be radical prostatectomy (RP), radiotherapy, androgen- deprivation therapy (ADT), or combinations of these. Traditionally, T3 prostate cancers are treated by radiotherapy. Recently, after the publication of the landmark trials by the Radiation Therapy Oncology Group and the European Organisation for the Research and Treatment of Cancer, the treatment of cT3 prostate cancer has changed towards a combination of radiotherapy and ADT. According to the guidelines of the European Association of Urology, RP is an accepted option in selected patients with small T3a tumours, a Gleason score of 5–7, a low PSA level and a life-expectancy of > 10 years [1]. Surgery for locally advanced prostate cancer is acceptable. The cancer-specific survival (CSS) at 5 and 10 years was 85% - 100% and 57% - 100%, respectively, and the respective overall survival (OS) was > 75% and 60% [2]. From our previous study [3], neoadjuvant ADT (nADT) can decrease the positive surgical margin (PSM) rate in cT2 tumours, but this was not the case in cT3 tumours. nADT might be of benefit in cT2 prostate cancer, but for cT3 tumours it remains controversial. ADT can cause gynaecomastia, hot flashes, and decrease libido and potency. The main question is whether the use of nADT can prevent or delay progression after surgery; thus, the objective of the present study was to compare the results in patients with unilateral cT3 prostate cancer treated with or with no nADT. PATIENTS AND METHODS Between 1987 and 2004, 2273 patients had RP at our institution; 235 (10.3%) were assessed as having unilateral cT3 disease by a DRE, and they were selected for surgery on the basis of limited, unilateral cT3a, any Gleason score, any PSA level and an Eastern Cooperative Oncology Group performance status of 0–1. Before surgery, 200 patients (8.8%) were not treated with nADT and 35 were. All patients had RP and bilateral pelvic lymphadenectomy. The mean (range) follow- up was 74.7 (7–184) months. The data were retrieved from patient files and from GPs by telephone for updated clinical and biochemical information. The DRE was performed by one of two senior urologists. Patients with unilateral T3a assessed by TRUS but not by DRE were excluded from the study. No patient received radiation therapy before surgery, while all patients had no evidence of nodal disease or distant metastasis on both contrast- enhanced CT of the pelvis, and a bone scan. If necessary, we used additional imaging of suspect lesions. Most of the patients were referred from a local hospital, and different nADT regimens were used before the patients arrived at our clinic; the interval from nADT to RP was 6–12 weeks. The last PSA value obtained before prostatic biopsies was used in the analysis.