Gomella L G, Liberman S N, Mulholland S G, Petersen R O, Hyslop T, Corn B W
Department of Urology, Thomas Jefferson University and the Jefferson Cancer Center, Philadelphia, Pennsylvania 19107-5097, USA.
Urology. 1996 Jun;47(6):870-7. doi: 10.1016/s0090-4295(96)00041-6.
There is interest in treating prostate cancer with induction androgen deprivation prior to radical prostatectomy. Data on long-term prostate-specific antigen (PSA)-based survival analyses among patients treated with neoadjuvant hormonal therapy (NHT) and prostatectomy are limited. In 1991 we instituted a pilot study for T3 disease based on endorectal coil magnetic resonance imaging (eMRI), mandatory negative laparoscopic nodal dissection prior to hormonal manipulation, and prostatectomy followed by pathologic and PSA-based outcome determinations.
Of 26 patients, 21 had negative laparoscopic lymphadenectomy followed by 4 months of NHT (leuprolide +/- flutamide) prior to radical prostatectomy. eMRI was performed at the time of diagnosis and following hormonal treatment. Serum PSA was determined at 3-month intervals. Prostatectomy specimens were evaluated by 3-mm whole-mount step sections.
Prior to prostatectomy, biochemical response was documented in all patients and downsizing was observed by eMRI in 57%. Pathologic downstaging to a lower stage (T2c or lower) was achieved in 48%. However, the actuarial 3-year freedom from biochemical relapse rate was only 24%.
Using laparoscopy to exclude node-positive patients and 4 months of NHT appears to result in pathologic and initial biochemical evidence of regression. These factors have not translated into improved freedom from biochemical relapse among patients with Stage T3 disease treated with NHT and prostatectomy. Recent data strongly suggest a beneficial effect in patients with clinical T2 disease treated with NHT and radical prostatectomy. The NGT and radical prostatectomy approach appeared to offer no clear advantage when compared with PSA-based benchmarks achieved with conformal irradiation or NHT followed by external beam treatment among patients with clinical T3 disease.
人们对在根治性前列腺切除术之前采用诱导雄激素剥夺疗法治疗前列腺癌很感兴趣。关于接受新辅助激素治疗（NHT）和前列腺切除术的患者基于前列腺特异性抗原（PSA）的长期生存分析数据有限。1991年，我们开展了一项针对T3期疾病的试点研究，该研究基于直肠内线圈磁共振成像（eMRI）、在激素治疗前进行强制性阴性腹腔镜淋巴结清扫，以及前列腺切除术后进行病理和基于PSA的结果判定。
26例患者中，21例进行了阴性腹腔镜淋巴结清扫，随后在根治性前列腺切除术之前接受了4个月的NHT（亮丙瑞林±氟他胺）。在诊断时和激素治疗后进行eMRI检查。每隔3个月测定血清PSA。前列腺切除标本通过3毫米连续全层切片进行评估。
在前列腺切除术之前，所有患者均记录到生化反应，通过eMRI观察到57%的患者肿瘤缩小。48%的患者病理分期降为较低阶段（T2c或更低）。然而，精算的3年无生化复发率仅为24%。
使用腹腔镜排除淋巴结阳性患者并进行4个月的NHT似乎能产生病理和初始生化方面的消退证据。但这些因素并未转化为接受NHT和前列腺切除术的T3期疾病患者无生化复发率的改善。近期数据强烈表明，对于接受NHT和根治性前列腺切除术的临床T2期疾病患者有有益效果。与临床T3期疾病患者采用适形放疗或NHT后进行外照射治疗所达到的基于PSA的基准相比，NGT和根治性前列腺切除术方法似乎没有明显优势。
