Neoadjuvant hormone treatment in localized prostate cancer : a clinical and histopathological study

Sammanfattning: Surgical treatment of localized prostate cancer may be hampered by the spread of cancer through the prostate capsule and in the surgical margins. The prostate is dependent on androgen hormones for its growth and function. In view of this relationship, the current investigation aimed to study the effect of three months of preoperative hormonal ablation achieved by administering a GnRH-agonist. The study group consisted of 40 consecutive patients 62+6 years of age. The findings were compared with those obtained in 54 patients of similar age who underwent surgery without being given hormonal pretreatment. Digital rectal and ultrasound examinations showed that the volume of the cancerous prostate gland decreased significantly during the preoperative period. Similar conclusions, regarding tumour volume (density), were reached when examining the prostatectomy specimens by using immunohistochemical techniques and colour-based image analyses. Nevertheless, all specimens obtained at prostatectomy contained cancerous lesions with extensive histopathological changes. These effects were not related to tumour grade and the DNA ploidy patterns were similar in hormone- and non-hormone-treated patients. The two groups differed in so far as cancer growth in the surgical margins was less frequently occurring in the hormone-treated patients (p<0.05). The patients were followed for three years with regard to the clinical findings and the levels of the prostate-specific antigen (PSA) in serum. At the end of the study 43% of the hormone-treated patients versus 16 % of the non-hormone-treated patients had PSA levels above the control range for prostatectomized subjects (p<0.05); this indicated that they still had prostate cancer. This difference seemed to be related to variations in tumour stage in the two groups. A comparison with other series of non-hormone-treated patients having localized prostate cancer provided no evidence that neoadjuvant hormone therapy during 3 months effectively inhibits post-operative cancer progression, with regard to clinical findings and number of patients with rising PSA levels.