Fair W R, Aprikian A G, Cohen D, Sogani P, Reuter V
Memorial Sloan-Kettering Cancer Center, New York, New York.
Clin Invest Med. 1993 Dec;16(6):516-22.
Radical prostatectomy is an excellent form of treatment of pathologically organ-confined prostatic carcinoma. However, most clinically localized prostatic cancers have pathologic evidence of extracapsular spread, limiting the effectiveness of radical surgery in curing this disease. To improve the organ-confined rate of prostate cancer, we studied the effect of preoperative or neoadjuvant androgen deprivation therapy (ADT). Our initial attempts focused on downstaging locally advanced tumors (T3) with neoadjuvant diethylstilbestrol (3 mg/d). Our study of 59 patients revealed that although there were significant clinical signs of downstaging, most patients still had extraprostatic disease. However, a subset of patients demonstrated marked pathologic regression, so we initiated a nonrandomized but controlled study of neoadjuvant ADT (goserelin acetate and flutamide for 3 months) followed by radical prostatectomy in patients with clinically localized prostate cancer. Of 72 control and 69 study patients, the rate of organ-confined disease was 48% and 74% (including 4% with no detectable residual carcinoma), respectively. In addition, the margin-positive rate was 33% and 10%, respectively. As demonstrated in the previous study, changes in serum prostate-specific antigen, transrectal ultrasonographic evaluations, and digital rectal examinations could not predict those patients with favourable pathology. Our results suggest that neoadjuvant ADT may improve the pathologic stage in some prostatic carcinomas and is worthy of further investigation in the efforts to augment the effectiveness of radical prostatectomy.
根治性前列腺切除术是治疗病理上局限于器官内的前列腺癌的一种极佳方法。然而，大多数临床局限性前列腺癌有包膜外扩散的病理证据，这限制了根治性手术治愈这种疾病的有效性。为了提高前列腺癌的器官局限性率，我们研究了术前或新辅助雄激素剥夺疗法（ADT）的效果。我们最初的尝试集中于用新辅助己烯雌酚（3毫克/天）使局部晚期肿瘤（T3）降期。我们对59例患者的研究表明，尽管有显著的临床降期迹象，但大多数患者仍有前列腺外疾病。然而，一部分患者表现出明显的病理退缩，因此我们开展了一项非随机但有对照的研究，对临床局限性前列腺癌患者先进行新辅助ADT（醋酸戈舍瑞林和氟他胺治疗3个月），然后行根治性前列腺切除术。在72例对照患者和69例研究患者中，器官局限性疾病的发生率分别为48%和74%（包括4%无可检测到的残留癌）。此外，切缘阳性率分别为33%和10%。如先前研究所示，血清前列腺特异性抗原的变化、经直肠超声评估和直肠指检无法预测那些病理结果良好的患者。我们的结果表明，新辅助ADT可能改善某些前列腺癌的病理分期，在提高根治性前列腺切除术有效性的努力中值得进一步研究。
