Traitement des cancers prostatiques A2-B2: résultats dʹune association hormonoradiothérapique dans lʹère du PSA

SummaryPurpose. ctive analysis of results of combined neoadjuvant hormonetherapy and extrnal beam radiation therapy in A2-B2 prostate adenocarcinoma. ts and methods. n 1986 and 1994, 36 patients with clinical stage A2 (five patients), B1 (12 patients) and B2 (19 patients) NO adenocarcinoma of the prostate declined for radical surgery, underwent a brief neoadjuvant hormonal therapy before external beam radiotherapy at our radiation therapy department. They all had a PSA determination before the combined treatment and no evidence of local extension or metastatic spread. They were followed clinically and with serial PSA levels for a median time of 58 months. Relapse was defined by a PSA level ≥ 2.5 ng/mL. s. pre-treatment PSA level was 16.5 ng/mL; 16 patients had less than 15 ng/mL. Combined treatment was very well tolerated. After 3 months of neoadjuvant hormonetherapy, digital rectal examination was normalized in 27 cases with a PSA value ≤ 1 ng/mL in 23. Only four tumors have relapsed (one local faillure, two metastases and one PSA failure). The single factor that predicted biochemical relapse was pre-treatment PSA level: the 5-year actuarial rate of PSA failure when PSA level < 15 ng/mL was 0% and 27.5% if it was ≥ 15 ng/mL (p = 0.05). During follow-up, only two patients suffered grade 2 rectitis and seven complained a total impotency. sion. imited study advocates hormonal neoadjuvant therapy and radiotherapy association in intracapsular prostatic carcinoma in patients declined for surgery or when pre-treatment PSA is above 15 ng/mL, with mild acute and late toxicity.