Polito M, Muzzonigro G, Minardi D, Montironi R
Institute of Urology, University of Ancona Medical School, Italy.
Eur Urol. 1996;30 Suppl 1:26-31; discussion 38-9. doi: 10.1159/000474242.
In this study, we analyzed the involutive effects of androgen deprivation therapy on normal and neoplastic prostatic tissue, to investigate whether androgen deprivation prior to radical prostatectomy could reduce the incidence of extracapsular extension, positive margins, positive seminal vesicles and positive lymph nodes in patients with prostatic carcinoma.
We performed neoadjuvant androgen deprivation therapy (NADT) in 41 patients cT2N0M0 and in 21 patients cT3N0M0. Criteria to evaluate the effectiveness of NADT included prostate volume, tumor volume, serum prostate-specific antigen (PSA), staging, grading, histological modifications of the tumor, and evaluation of indices of cellular proliferation.
We observed a decrease in prostate and tumor volume, as well as serum PSA; a down-staging effect was observed in 14.51% of cases. Evaluation of proliferating-cell nuclear antigen (PCNA) revealed a decrease of proliferative activity in treated prostatic carcinoma. The histological modifications after neoadjuvant therapy consisted of cellular necrosis with apoptotic phenomena, dense chromatin without nucleoli, absence of mitosis, inflammatory infiltrate, and interstitial fibrosis. Regressive aspects similar to those of neoplastic cells were observed in prostatic intraepithelial neoplasia.
Our assessment of the biologic effects of NADT on tumoral activity of prostatic carcinoma led us to conclude that NADT can reduce the cellular proliferation of neoplastic cells.
在本研究中，我们分析了雄激素剥夺疗法对正常和肿瘤性前列腺组织的 involutive 效应，以调查在前列腺癌患者中，根治性前列腺切除术之前进行雄激素剥夺是否能降低包膜外侵犯、切缘阳性、精囊阳性和淋巴结阳性的发生率。
我们对41例 cT2N0M0 和21例 cT3N0M0 患者进行了新辅助雄激素剥夺疗法（NADT）。评估 NADT 有效性的标准包括前列腺体积、肿瘤体积、血清前列腺特异性抗原（PSA）、分期、分级、肿瘤的组织学改变以及细胞增殖指标的评估。
我们观察到前列腺和肿瘤体积以及血清 PSA 均下降；14.51%的病例观察到降期效应。增殖细胞核抗原（PCNA）评估显示，治疗后的前列腺癌增殖活性降低。新辅助治疗后的组织学改变包括伴有凋亡现象的细胞坏死、无核仁的致密染色质、无有丝分裂、炎性浸润和间质纤维化。在前列腺上皮内瘤变中观察到与肿瘤细胞相似的退行性改变。
我们对 NADT 对前列腺癌肿瘤活性的生物学效应的评估使我们得出结论，NADT 可降低肿瘤细胞的增殖。
