Follow-up of nondetectable prostate carcinoma (pT0) after prolonged PSA-monitored neoadjuvant hormonal therapy followed by radical prostatectomy.

Objectives: To test the hypothesis that in patients with Stage pT0 after prolonged prostate-specific antigen (PSA)-monitored neoadjuvant endocrine therapy, biochemical relapse is extremely rare and derives from systemic tumor recurrence.

Methods: A total of 227 patients with Stage cT1-3 carcinoma underwent PSA-monitored prolonged neoadjuvant endocrine treatment followed by radical prostatectomy. In all pT0 patients, PSA follow-up data were obtained. Patients with a PSA relapse (0.2 ng/mL or greater) underwent biopsy from the vesicourethral anastomosis, and some underwent radiotherapy.

Results: Stage pT0 was diagnosed in 38 (16.7%) of 227 patients. The pT0 rate in those with cT1, cT2, and cT3 cancer was 28.2% (11 of 39), 26.3% (20 of 76), and 6.25% (7 of 112), respectively. In Gleason score 2 to 4, 5 to 6, and 7 to 10 carcinoma, the pT0 rate was 50% (3 of 6), 28.4% (25 of 88), and 7.1% (9 of 126), respectively. The median follow-up was 47.0 months (range 20 to 180). PSA relapse was seen in 7 (18.4%) of 38 patients. PSA relapse derived from local tumor relapse in 2 cases, local and systemic tumor relapse in 1 case, and local benign prostate glands in 2 cases. In 2 cases, the nature of the PSA relapse remained unknown.

Conclusions: Mainly clinically organ-confined, low and intermediate-grade tumors were converted to Stage pT0. Local PSA relapse was surprisingly frequent. In part, its malignant nature was confirmed histologically. However, the finding of residual benign prostate glands shows that PSA relapse does not always correspond with tumor relapse. Whether the prognosis in pT0 patients is significantly improved compared with nonpretreated patients cannot be answered on the basis of our data. Nevertheless, the presented results were disappointing.