Montironi R, Schulman C C
Institute of Pathological Anatomy and Histopathology, University of Ancona, Ospedale Regionale, Torrette, Italy.
J Clin Pathol. 1998 Jan;51(1):5-12. doi: 10.1136/jcp.51.1.5.
The number of newly diagnosed cases of prostate cancer has doubled in the past four years because of the aging of the population coupled with growing awareness of the importance of early detection. The issues of clinical understaging and resection limit positivity have led to the development of novel management practices, including neoadjuvant hormonal treatment, which aims to downstage the primary tumour and decrease the positive margin rate before definitive localised treatment (radical prostatectomy or definitive radiation treatment (neoadjuvant)). There is conflicting evidence regarding pathological downstaging, with some studies suggesting benefit and others no benefit of androgen manipulation before radical prostatectomy. The problem might be related to incomplete sampling of the prostates and difficulties associated with the pathological interpretation of morphological changes. The least controversial aspect of neoadjuvant treatment is its impact on surgical margins. Most series have shown that neoadjuvant treatment in clinical T2 tumours is associated with a 20-25% decrease in positive margins in radical prostatectomy specimens. In patients with clinical T3 tumours, the effects of neoadjuvant treatment on positive margins are less clear. Even if some early significant advantages can be observed following hormonal treatment this may not alter the metastatic spread and overall survival rate. Only long term follow up studies evaluating biological and clinical failures, time to progression, and survival will allow definitive conclusions from this approach.
由于人口老龄化以及对早期检测重要性的认识不断提高，前列腺癌新诊断病例数在过去四年中翻了一番。临床分期不足和切除切缘阳性率的问题促使了新的治疗方法的发展，包括新辅助激素治疗，其目的是在确定性局部治疗（根治性前列腺切除术或确定性放疗（新辅助））之前降低原发肿瘤分期并降低切缘阳性率。关于病理降期存在相互矛盾的证据，一些研究表明在根治性前列腺切除术之前进行雄激素操控有益，而另一些研究则表明无益处。这个问题可能与前列腺取样不完整以及形态学变化的病理解读困难有关。新辅助治疗最无争议的方面是其对手术切缘的影响。大多数系列研究表明，临床T2期肿瘤的新辅助治疗与根治性前列腺切除标本中切缘阳性率降低20%-25%相关。对于临床T3期肿瘤患者，新辅助治疗对切缘阳性率的影响尚不清楚。即使在激素治疗后可以观察到一些早期显著优势，但这可能不会改变转移扩散和总体生存率。只有评估生物学和临床失败、进展时间和生存率的长期随访研究才能得出这种方法的确切结论。
