Hachiya T, Kobayashi K, Ichinose T, Ishida H, Okada K
Department of Urologyk, Nihon University, School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1997 Nov;88(11):936-44. doi: 10.5980/jpnjurol1989.88.936.
Extracapsular extension is commonly seen in patients undergoing radical prostatectomy for localized prostate cancer due to understaging of disease. One possible approach to reduce the likelihood of extracapsular disease is androgen deprivation prior to radical prostatectomy, neoadjuvant therapy. However, adequate application is not clear. We analyzed the outcome of neoadjuvant therapy and radical prostatectomy in an attempt to expand our understanding on indications of neoadjuvant therapy.
Forty-six selected patients with clinical T1 or T2 prostate cancer were retrospectively reviewed. Twenty-two patients underwent neoadjuvant therapy (group N) that mainly consists of LH-RH agonist. The duration of neoadjuvant therapy, varied from 1 to 12 months with the mean being 4 months. Twenty-four underwent radical prostatectomy alone (group S).
In the group N and group S, 59% and 33% had either organ confined disease (OCD) or specimen confined disease (SCD) respectively. When the patients had OCD or SCD, they were defined as surgically cured patients. In the patients with clinical stage T1b, T1c, and T2 disease, likelihood of surgical cure were 100%, 50%, 46.7% in group N, 100%, 20%, 11%, in group S respectively. In the patients with initial serum PSA less than 10 ng/ml and more than 10.1 ng/ml, likelihood of surgical cure were 83.3% and 50% in group N, 63.6% and 15.4% in group S, respectively. Likelihood of surgical cure was higher in the patients with well differentiated carcinoma both in group N and group S. All the patients with serum PSA less than 0.1 ng/ml after neoadjuvant therapy had OCD.
Neoadjuvent therapy could be beneficial either in the patients with moderately or in the poorly differentiated adenocarcinoma of prostate especially in the group with initial serum PSA more than 10.1 ng/ml. However, in patients both with well differentiated adenocarcinoma and the initial serum PSA less than 10 ng/ml, no evidence of beneficial effect on the likelihood of OCD or SCD was observed. PSA after neoadjuvant therapy could be useful predictor for the pathological outcome.
由于疾病分期不足，在接受局限性前列腺癌根治性前列腺切除术的患者中，包膜外侵犯很常见。一种降低包膜外疾病发生可能性的方法是在根治性前列腺切除术之前进行雄激素剥夺，即新辅助治疗。然而，其恰当应用尚不清楚。我们分析了新辅助治疗和根治性前列腺切除术的结果，以加深我们对新辅助治疗适应证的理解。
对46例经选择的临床T1或T2期前列腺癌患者进行回顾性研究。22例患者接受了主要由促黄体激素释放激素（LH-RH）激动剂组成的新辅助治疗（N组）。新辅助治疗的持续时间为1至12个月，平均为4个月。24例患者仅接受了根治性前列腺切除术（S组）。
在N组和S组中，分别有59%和33%的患者患有器官局限性疾病（OCD）或标本局限性疾病（SCD）。当患者患有OCD或SCD时，他们被定义为手术治愈患者。在临床分期为T1b、T1c和T2期的患者中，N组的手术治愈可能性分别为100%、50%、46.7%，S组分别为100%、20%、11%。在初始血清前列腺特异抗原（PSA）小于10 ng/ml和大于10.1 ng/ml的患者中，N组的手术治愈可能性分别为83.3%和50%，S组分别为63.6%和15.4%。N组和S组中高分化癌患者的手术治愈可能性均较高。新辅助治疗后血清PSA小于0.1 ng/ml的所有患者均患有OCD。
新辅助治疗对于前列腺中分化或低分化腺癌患者可能有益，尤其是对于初始血清PSA大于10.1 ng/ml的患者。然而，在高分化腺癌且初始血清PSA小于10 ng/ml的患者中，未观察到对OCD或SCD发生可能性有有益影响的证据。新辅助治疗后的PSA可能是病理结果的有用预测指标。
