Identification of intermediate-risk prostate cancer patients treated with radical radiotherapy suitable for neoadjuvant hormone studies

We undertook a retrospective review of patients presenting with apparently localised prostatic carcinoma to a single practitioner for consideration of radiation therapy to clarify the characteristics of those patients who might benefit from the use of neo-adjuvant androgen deprivation. OF 133 patients referred between January 1989 and June 1994, 85 were considered suitable for radical therapy, of whom 31 were treated with hormone therapy prior to radiotherapy, frequently on the basis of an elevated PSA. Increasing PSA levels (p = 0.0016) and Gleason grade (p = 0.026) were independent variables for relapse. It uas possible to define three prognostic groups of patients, on the basis oi initial PSA and Gleason grade. Those of intermediate risk (PSA < 10 mu g/l, Gleason score 8-10; PSA 10-25 mu g/l, Gleason 5-7 or 8-10; PSA > 25 mu g/l, Gleason score 2-4) had a superior duration of disease-free survival ii given initial hormone therapy. This group of patients is potentially the most likely to benefit from such an approach and should be enrolled in prospective randomised studies of neoadjuvant androgen deprivation.