[Predictive value of the serum PSA level in patients having undergone neo-adjuvant hormone treatment before radical prostatectomy].

Great interest has been generated recently in preoperative androgen deprivation for clinical stage B ou C (T2 ou T3) prostate cancer. The influence of neoadjuvant hormonal therapy on down-staging and down-grading is still controversial. To assess the influence of preoperative androgen deprivation on serum PSA levels, we compared pre- and post-treatment serum PSA levels in 54 patients who received complete pre-operative androgen blockade (LHRH agonist + flutamide) 3 months prior to surgery. All patients with a pretreatment PSA > 20 ng/ml had extra-prostatic disease excepted two patients who presented lesions of acute prostatitis with adenocarcinoma. After hormonal deprivation, 51/54 patients experienced a return of PSA to normal values (< 4 ng/ml). Among this patient, 33 had undetectable PSA levels (< 0.25 ng/ml). 90% of the patients with undetectable had tumor confined to the gland (pT2/B). On the other hand, patients who still have PSA > 4 ng/ml after hormonal deprivation, had extra-prostatic cancer (pT3-pT4). Thus, PSA levels after 3 months neo-adjuvant hormonal treatment might have a useful predictive value in patients selection for radical surgery.