Kiriyama Isao, Ogaki Kenji, Ohba Shuji, Nishimura Taiji
Department of Urology, Tohsei National Hospital, Shizuoka, Japan.
J Nippon Med Sch. 2002 Oct;69(5):422-7. doi: 10.1272/jnms.69.422.
The effect of neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy (RP) on pathological downstaging of prostate cancer and biochemical relapse of serum prostate specific antigen (PSA) level was evaluated.
Twenty selected patients with prostate cancer, who were treated with hormonal therapy and demonstrated biochemical downstaging by reduction of PSA prior to RP and bilateral pelvic node dissection at the Tohsei National Hospital between January 1997 and August 2001, are reported on. The complete RP specimens of these 20 men were used for accurate evaluation of the pathological stage. All 20 patients received NHT; ten patients were treated with leuprolide plus flutamide and 10 received leuprolide plus chlormadinone acetate (CMA).
Decreases in serum PSA values were demonstrated from a pre-hormonal average of 49.7 ng/ml to an average of 0.52 ng/ml after NHT. Of the three clinical stages, A2-C, for cancer patients, two of the 20 patients had stage A2, two had stage B1, nine had stage B2, and seven had stage C. Of the 20 patients with biochemical downstaging, two had pathological stage B1, seven had pathological stage B2, eight had pathological stage C, and three had positive pelvic lymph nodes. Ten (50%) of the 20 patients were reported to have positive surgical margins. Seminal vesical extension was observed in two cases, and penetration was not observed. Positive nodes were identified in three (15%) patients. Among the seven clinical stage C patients, one had pathological stage B1 disease and two had pathological stage B2. Four of nine patients with clinical stage B2 prostatic cancer had pathological stage C disease. The actuarial incidence of a rising PSA at 3 years for the leuprolide plus CMA group was 28.9% compared with 37.5%for the group receiving leuprolide plus flutamide. The cases of biochemical relapse did not necessarily indicate a high stage and had no tendency to be high for baseline PSA level, positive margin rates or Gleason scores.
A significant decrease in the rate of penetration could be observed after NHT, though it was not so effective for pathological downstaging, and changes in the preoperative PSA level did not predict those patients who might have a favorable result.
评估根治性前列腺切除术（RP）前新辅助激素治疗（NHT）对前列腺癌病理降期及血清前列腺特异性抗原（PSA）水平生化复发的影响。
报告了20例经选择的前列腺癌患者，他们于1997年1月至2001年8月在东海国立医院接受激素治疗，并在RP和双侧盆腔淋巴结清扫术前通过PSA降低表现出生化降期。这20名男性的完整RP标本用于准确评估病理分期。所有20例患者均接受NHT；10例患者接受亮丙瑞林加氟他胺治疗，10例接受亮丙瑞林加醋酸氯地孕酮（CMA）治疗。
血清PSA值从激素治疗前的平均49.7 ng/ml降至NHT后的平均0.52 ng/ml。在癌症患者的三个临床分期A2 - C中，20例患者中有2例为A2期，2例为B1期，9例为B2期，7例为C期。在20例生化降期的患者中，2例病理分期为B1期，7例为B2期，8例为C期，3例盆腔淋巴结阳性。20例患者中有10例（50%）报告手术切缘阳性。观察到2例有精囊侵犯，未观察到穿透。3例（15%）患者发现阳性淋巴结。在7例临床C期患者中，1例病理分期为B1期疾病，2例为B2期疾病。亮丙瑞林加CMA组3年时PSA升高的精算发病率为28.9%，而接受亮丙瑞林加氟他胺组为37.5%。生化复发的病例不一定表明分期高，且在基线PSA水平、切缘阳性率或Gleason评分方面没有升高的趋势。
NHT后可观察到侵犯率显著降低，尽管对病理降期效果不佳，且术前PSA水平的变化无法预测哪些患者可能有良好结果。
