Cher M L, Shinohara K, Breslin S, Vapnek J, Carroll P R
Department of Urology, University of California School of Medicine, San Francisco, USA.
Br J Urol. 1995 Jun;75(6):771-7. doi: 10.1111/j.1464-410x.1995.tb07389.x.
To evaluate whether neoadjuvant androgen deprivation before radical prostatectomy decreases tumour stage in patients with stage C prostatic cancer and to estimate the efficacy of cancer control achieved with this form of treatment.
Thirty men (mean age 65 years, range 52-74) with clinical stage C adenocarcinoma of the prostate were included in a phase II trial of neoadjuvant androgen deprivation (luteinizing hormone-releasing hormone agonist and an antiandrogen) before radical prostatectomy. The timing and extent of the changes in serum prostate specific antigen (PSA) levels and both prostate and cancer volume were recorded. Twenty-six men underwent radical prostatectomy with pelvic lymphadenectomy, two had pelvic lymphadenectomy alone, one had pelvic lymphadenectomy with radiotherapy and one refused additional treatment despite significant reductions in tumour volume and PSA while undergoing androgen deprivation.
The toxicity of the treatment was low. Significant reductions in prostatic volume (mean 35%), tumour volume (mean 50%) and PSA concentrations (mean 96%) occurred in all patients, with the maximum reductions recorded during the first 2 months of androgen deprivation. However, despite significant physiological changes in prostate and tumour volume, tumour stage was reduced in only four patients. Of the patients who were surgically staged 41% were ultimately identified as having more advanced disease, including lymph node metastases in 21%. Overall, with a mean follow-up of 32.7 months, 72% of patients had evidence of disease recurrence, including detectable PSA. Of 26 patients who underwent radical prostatectomy, local recurrence occurred in five (19%), distant recurrence in one (4%) and both local and distant recurrence in one (4%).
This study suggests that tumour stage reduction is uncommon in patients with stage C prostatic cancer treated with neoadjuvant androgen deprivation followed by radical prostatectomy. Furthermore, local and distant recurrences, as well as detectable levels of PSA, are common after such treatment.
评估根治性前列腺切除术前行新辅助雄激素剥夺治疗是否能降低C期前列腺癌患者的肿瘤分期，并评估这种治疗方式实现癌症控制的疗效。
30例前列腺临床C期腺癌男性患者（平均年龄65岁，范围52 - 74岁）纳入一项新辅助雄激素剥夺治疗（促黄体激素释放激素激动剂和一种抗雄激素药物）联合根治性前列腺切除术的II期试验。记录血清前列腺特异性抗原（PSA）水平、前列腺及癌体积变化的时间和程度。26例患者接受了根治性前列腺切除术及盆腔淋巴结清扫术，2例仅接受了盆腔淋巴结清扫术，1例接受了盆腔淋巴结清扫术及放疗，1例在接受雄激素剥夺治疗期间尽管肿瘤体积和PSA显著降低但拒绝进一步治疗。
治疗毒性较低。所有患者的前列腺体积（平均减少35%）、肿瘤体积（平均减少50%）和PSA浓度（平均减少96%）均显著降低，最大降幅出现在雄激素剥夺治疗的前2个月。然而，尽管前列腺和肿瘤体积有显著的生理变化，但仅4例患者的肿瘤分期降低。在接受手术分期的患者中，41%最终被确定患有更晚期疾病，其中21%有淋巴结转移。总体而言，平均随访32.7个月，72%的患者有疾病复发证据，包括可检测到的PSA。在26例接受根治性前列腺切除术的患者中，5例（19%）发生局部复发，1例（4%）发生远处复发，1例（4%）同时发生局部和远处复发。
本研究表明，C期前列腺癌患者在接受新辅助雄激素剥夺治疗后再行根治性前列腺切除术，肿瘤分期降低并不常见。此外，这种治疗后局部和远处复发以及可检测到的PSA水平很常见。
