Voges G E, Mottrie A M, Fichtner J, Mappes C, Störkel S, Stöckle M, Hohenfellner R
Department of Urology, Mainz Medical School, Germany.
Eur Urol. 1995;28(3):209-14. doi: 10.1159/000475053.
Eighty-two patients with stage T3 carcinoma of the prostate were treated for 3 months prior to radical retropubic prostatectomy with a luteinizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor size was noted in all cases. Ultrasound demonstrated a decrease in prostatic volume between 0 and 62.5% (median 32%). Prostate-specific antigen levels (PSA, Hybritech) decreased substantially (mean PSA of 29.5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). Pathologically, only 15 patients (18.3%) had organ-confined disease (stage pT2), 44 (53.7%) had stage pT3 tumors and 22 (26.8%) had positive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the histological grade was found in only 7 tumors, while an increase was noted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T3 prostate cancer after 3 months of maximum androgen deprivation. This cannot be confirmed pathologically. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.
82例T3期前列腺癌患者在耻骨后根治性前列腺切除术前行3个月的促黄体激素释放激素类似物和抗雄激素治疗。根据直肠指检（DRE），所有病例均发现前列腺和肿瘤大小减小。超声显示前列腺体积减少0至62.5%（中位数32%）。前列腺特异性抗原水平（PSA，Hybritech）大幅下降（激素治疗前平均PSA为29.5 ng/ml，治疗后平均PSA为1.3 ng/ml）。病理检查显示，仅15例患者（18.3%）有器官局限性疾病（pT2期），44例（53.7%）有pT3期肿瘤，22例（26.8%）有淋巴结转移。在1份手术标本（1.2%）中未发现残留肿瘤。在5例有淋巴结转移和13例有精囊侵犯的患者中，治疗前PSA水平低于0.5 ng/ml。与术前穿刺活检相比，仅7例肿瘤组织学分级降低，26例升高。DRE、超声和PSA提示最大雄激素剥夺3个月后T3期前列腺癌分期降低。但这在病理上无法得到证实。关于这种治疗方案的前瞻性研究应集中在对局部和远处癌症控制及生存可能的益处上。
