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

Abstract: Neoadjuvant hormone treatment in localized prostate cancer, a clinical andhistopathological studyMagnus Hellström, Karolinska Institute Danderyd Hospital, Division of Urology, S-182 88 Danderyd, SwedenSurgical treatment of localized prostate cancer may be hampered by the spread of cancer through theprostate capsule and in the surgical margins. The prostate is dependent on androgen hormones for itsgrowth and function. In view of this relationship, the current investigation aimed to study the effect ofthree 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 comparedwith those obtained in 54 patients of similar age who underwent surgery without being given hormonalpretreatment.Digital rectal and ultrasound examinations showed that the volume of the cancerous prostate gland de-creased significantly during the preoperative period. Similar conclusions, regarding tumour volume(density), were reached when examining the prostatectomy specimens by using immunohistochemicaltechniques and colour-based image analyses. Nevertheless, all specimens obtained at prostatectomy con-tained cancerous lesions with extensive histopathological changes. These effects were not related totumour grade and the DNA ploidy patterns were similar in hormone- and non-hormone-treated patients.The two groups differed insofar as cancer growth in the surgical margins was less frequently occurring inthe hormone-treated patients (p<0.05).The patients were followed for three years with regard to the clinical findings and the levels of theprostate-specific antigen (PSA) in serum. At the end of the study 43% of the hormone-treated patientsversus 16 % of the non-hormone-treated patients had PSA levels above the control range for prostatec-tomized subjects (p<0.05); this indicated that they still had prostate cancer. This difference seemed to berelated 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 therapyduring 3 months effectively inhibits post-operative cancer progression, with regard to clinical findingsand number of patients with rising PSA levels.Key words: Localized prostate cancer, radical prostatectomy, neo-adjuvant androgen deprivation, GnRH-agonist, histopathology, immunohistochemistry, image analysis, cancer volume, DNA ploidy patterns,PSA in serum, follow-up, prognosisStockholm 1996 ISBN 91-628-2071-0