Prognostic factors in prostate cancer with special reference to the effect of hormonal therapy
Abstract: We have used image cell analysis to analyse nuclear DNA content on fine needle aspiration biopsies from 96 patients diagnosed to have prostate cancer 1980-81. By stratifying diploid and tetraploid tumours according to a cytometric proliferation index (PI), we suggest a new DNA-classification that is prognostic of death from prostate cancer in multivariate analysis including conventional prognostic factors. Patients with diploid tumours and a low PI, had almost no mortality from prostate cancer with mean 14.5 years follow-up. We used the same method on imprints of ultrasound guided tissue biopsies in a prospective study on 137 patients. The pognostic value of the new DNA-classification was confirmed although the follow-up is limited to 39 months. Prognostic factors of the risk of recurrence and of hormone dependence in prostate cancer were studied in a randomised prospective study comparing 3 months neoadjuvant GnRh-analouge treatment followed by radical prostatectomy (55 patients) and surgery alone (56 patients). We found tumour growth at the surgical margin of the specimen to be reduced by hormonal treatment prior to surgery (p<0.001) in large tumours (T2c-T3a). This finding did not correlate to an improved cure rate after more than 3 years follow up. Tumour cell proliferation in the primary tumour was found to be a highly significant prognostic factor of recurrence in multivariate analysis after combined hormonal and surgical treatment (p=0.0002). Neuroendocrine (NE) differentiation in the primary tumour increased after neoadjuvant hormonal treatment but was not associated with the extension of regressive changes or prognosis. Instead, NE-differentiation in the tumour correlated to tumour volume, wich was prognostic of treatment failure in both treatment arms.
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