Kameoka Hiroshi, Katayose Kouichi, Kumakawa Kenjiro, Shiraiwa Yasuo, Uchida Hisashi, Takahashi Yoshio, Yazaki Junji, Yamaguchi Osamu
Dept. of Urology, Hoshi General Hospital, Jusendo General Hospital.
Gan To Kagaku Ryoho. 2005 Jan;32(1):57-63.
Even in the cases of localized prostate cancer, there are a substantial number of patients who undergo endocrine therapy, and their prognosis is affected by the treatment. We evaluated the histological effect of endocrine therapy and analyzed its correlation with prognosis.
Seventy-seven cases with localized prostate cancer who underwent maximal androgen blockade (MAB) therapy 1 year or longer were pathologically evaluated using repeat biopsy specimens from November 1994 to October 2001. The relationship between clinical parameters and histological effect in repeat biopsy specimens was examined. Biopsy was conducted mainly by the 6-site systematic method, and the histological effect was judged in accordance with the General Rules for Clinical and Pathological Study of Prostate Cancer (3rd edition). The median re-biopsy and follow-up periods were 13 months and 41 months, respectively.
Using this criteria for the histological effects of anti-cancer treatment, the histological effect of endocrine therapy was most frequently observed in class G3b with 61.0%, and correlations with PSA nadir and initial biopsy positive number before endocrine therapy were observed. After biopsy, radical prostatectomy was performed on 9 patients (endocrine therapy was concurrently performed on 4), endocrine therapy on 67 (intermittent administration on 21), and radiation therapy on 1 (MAB was concurrently performed). Outcomes included PSA failure in 14, of whom 2 died of cancer. Three-year and 5-year PSA-failure free survival rates were 91.1% and 76.3%, respectively. Pathological disease stage in radical prostatectomy specimens was examined by dividing it into class G0-2 and class G0-3. This revealed a significant correlation between histological effect and pathological disease stage (pT2-3). PSA-failure free survival was analyzed in 67 of the 77 patients who underwent endocrine therapy. A significantly large number of PSA-failures occurred in class G0-2. Multivariate analysis revealed that the histological effect alone was the influencing factor in PSA-failure.
A strong histological effect by MAB 1 year or longer after treatment was observed on localized prostate cancer. Evaluation of the histological effect by the present method was considered to be a useful predictor for organ-confined disease after radical prostatectomy and endocrine therapy for PSA-failure.
即使在局限性前列腺癌病例中，也有相当数量的患者接受内分泌治疗，且其预后受该治疗影响。我们评估了内分泌治疗的组织学效果，并分析了其与预后的相关性。
1994年11月至2001年10月，对77例接受了1年或更长时间最大雄激素阻断（MAB）治疗的局限性前列腺癌患者，使用重复活检标本进行病理评估。检查了重复活检标本中临床参数与组织学效果之间的关系。活检主要采用6位点系统法进行，组织学效果根据前列腺癌临床与病理研究总则（第3版）进行判断。再次活检和随访的中位时间分别为13个月和41个月。
根据该抗癌治疗组织学效果的标准，内分泌治疗的组织学效果最常出现在G3b级，占61.0%，且观察到其与内分泌治疗前的PSA最低点及初始活检阳性数相关。活检后，9例患者接受了根治性前列腺切除术（其中4例同时进行了内分泌治疗），67例接受了内分泌治疗（21例为间歇性给药），1例接受了放射治疗（同时进行了MAB）。结果包括14例出现PSA失败，其中2例死于癌症。3年和5年无PSA失败生存率分别为91.
