Treated prostatic carcinoma. Histological, immunohistochemical and cell kinetic studies.

Classification, histological and cytological grading of prostatic carcinomas, as well as the exact determination of the tumor stage, are the decisive criteria for the therapy to be followed. 163 morphological control examinations were analyzed for a period of 5 years on 97 patients before, under and after hormonal or radiotherapy. 57% of the controlled prostatic carcinomas were uniformly glandular, or predominantly glandular, i.e., of pluriform structure, malignity grade Ib/IIa. 41% corresponded to cribriform and solid trabecular carcinomas with grade IIa, IIb and III. Under hormonal therapy, the typical epithelial and stromal changes were evident, like coarse vacuolization of cytoplasm, progressive nuclear pyknosis, stroma edema, as well as stroma sclerosis and hyalinosis. Under radiotherapy, the degree of stroma sclerosis and nuclear changes was even more evident. Polynuclear, bizarre tumor cells predominated. With responsiveness of the carcinomas to hormonal or radiotherapy, the immunohistochemical markers (prostate-specific antigen, acid prostate phosphatase) were markedly reduced or missing. Glandular carcinomas, up to 5 years after therapy, showed regression grade I in 30.1%, II in 18.3, III in 43.0% and X in 8.6%. In cribriform/solid trabecular carcinomas, the regression was less marked. Grade I was observed in 42.9%, grade II in 21.4%, and grade III in 35.7% of the cases. There was no regression grade X. The results have shown that responsiveness of carcinomas to therapy can well be analyzed by use of certain histological and cytological criteria for grading and regressional grading. The experiences so far have shown that concerning radiation, 12-18 months after conclusion of therapy is a favorable moment for posttherapy controls. Under hormonal therapy, the therapy control should be performed 6 months after beginning. The same applies for cytological therapy controls.