Labrie F, Cusan L, Gomez J L, Diamond P, Suburu R, Lemay M, Tetu B, Fradet Y, Bélanger A, Candas B
Prostate Cancer Research Unit, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University Medical Center, Canada.
Urology. 1997 Mar;49(3A Suppl):56-64. doi: 10.1016/s0090-4295(97)00170-2.
To assess the effect of neoadjuvant combination therapy with the antiandrogen flutamide and a luteinizing-hormone-releasing hormone (LHRH) agonist administered for 3 months before radical prostatectomy, compared with surgery alone in early stage prostate cancer on histopathologic findings at surgery and serum prostate-specific antigen (PSA).
A sample of 161 randomly screened patients diagnosed as having stage B (134 patients) or C (27 patients) prostate cancer were randomly assigned to radical prostatectomy alone or to 3 months of neoadjuvant combination therapy with the antiandrogen flutamide and an LHRH agonist before radical prostatectomy.
Neoadjuvant combination therapy before radical prostatectomy decreased cancer-positive surgical margins from 33.8% in the control group to only 7.8%, thus leaving 92.2% of patients with negative margins at surgery. A net 54% improvement of staging was observed in favor of combination therapy. Organ-confined disease, on the other hand, increased from 49.3% to 77.8% of patients after 3 months of combination therapy, for a 57.8% increase in the incidence of organ-confined disease. No cancer was found in 6 (6.7%) prostatectomy specimens from the treated group. A close correlation was found between serum PSA at diagnosis and the stage of the disease at surgery. Upstaging increased from 30% at serum PSA values of 0 to 3.0 ng/mL up to 100% at serum PSA values above 15 ng/mL.
Although long-term follow-up of these patients is required to determine the impact on survival, the marked influence of neoadjuvant combination therapy on the stage of the disease suggests the possibility of a major improvement in the morbidity and mortality from prostate cancer.
评估在根治性前列腺切除术前行3个月抗雄激素氟他胺和促黄体生成激素释放激素（LHRH）激动剂新辅助联合治疗的效果，与早期前列腺癌单纯手术治疗相比，观察其对手术时的组织病理学结果及血清前列腺特异性抗原（PSA）的影响。
161例经随机筛选诊断为B期（134例）或C期（27例）前列腺癌的患者，随机分为单纯根治性前列腺切除术组或在根治性前列腺切除术前行3个月抗雄激素氟他胺和LHRH激动剂新辅助联合治疗组。
根治性前列腺切除术前行新辅助联合治疗使癌阳性手术切缘从对照组的33.8%降至仅7.8%，从而使92.2%的患者手术时切缘阴性。联合治疗组分期净改善率达54%。另一方面，联合治疗3个月后，器官局限性疾病患者比例从49.3%增至77.8%，器官局限性疾病发生率增加了57.8%。治疗组6例（6.7%）前列腺切除标本中未发现癌细胞。诊断时血清PSA与手术时疾病分期密切相关。血清PSA值在0至3.0 ng/mL时，分期上调率为30%，而血清PSA值高于15 ng/mL时，分期上调率达100%。
尽管需要对这些患者进行长期随访以确定对生存的影响，但新辅助联合治疗对疾病分期的显著影响提示前列腺癌的发病率和死亡率可能会有重大改善。
