Histological effects of endocrine therapy on prostatic cancer

Histological effects of endocrine therapy were evaluated in one hundred and four prostatic cancer patients by new criteria presented by the committee of "General Rule for Clinical and Pathological Studies on Prostatic Cancer". Route and time of biopsy, clinical stage and histological grade were related to histological effects. Biopsy specimens taken within three months from the start of the therapy tended to score rather low marks and this tendency is especially apparent with low grade cancers. Histological effects evaluated by the present method correlated well with prognosis in localized stages (stage B, C and D1). In metastatic cases, however, local effects were not related to the prognosis.     

Thermochemotherapy of prostatic cancer]

We performed hyperthermia concomitantly with the use of anticancer agents (etoposide and peplomycin) for the treatment of 13 patients with prostatic cancer. Seven of them were new cases and the others were recurrent ones. After intravenous administration of etoposide and peplomycin, hyperthermia was applied twice a week for 10 times in total. Clinical efficiency was evaluated by CT, ultrasound, prostatic biopsy. Tumor regression were observed in 12 cases. According to the General Rule for Clinical and Pathological Studies on Prostatic Cancer by Japanese Urological Association and the Japanese Pathological Society, one case of Ef2 and 5 cases of Ef1 were obtained with this treatment. Side effects caused by hyperthermia were urethral pain (1 case) and skin burning (1 case) noted.     

Chemotherapy of prostatic cancer]

CDDP combined chemotherapy was performed in 55 cases out of 229 prostatic cancer patients who were treated in Nara Medical University and Nara Prefectural Nara Hospital between January 1979 and August 1989. The previously untreated 33 patients received chemotherapy with anti-androgen treatment as an initial treatment, as well as 7 cases of unresponsive to antiandrogen treatment, 14 relapsing cases and one case with recurrence after total prostatectomy. The major regimens of chemotherapy were cis-diammine dichloroplatinum (CDDP) alone in 16 cases, PVB regimen (bleomycin or peplomycin + vincristine + CDDP) in 19 cases, and CAP regimen (cyclophosphamide + adriamycin + CDDP) in 16 cases. Complete response was not achieved or partial response was observed in 20 cases (34%), no change was seen in 20 cases (34%), and progression was seen in 19 cases (32%). Among each evaluable lesion, effects (CR + PR) were observed in 40% in the prostate, in 18% in the bone lesions, in 44% in the soft tissue lesions, and in 42% in the prostatic tumor marker. The 7-year survival rate of the chemotherapy group (35.6%) was better than that of the antiandrogen treatment group (26.6%) in stage D patients, but was not significant statistically When evaluated by the regimen, a partial response was observed in 56% of CDDP alone, in 21% of PVB regimen, and in 38% of the CAP regimen. However, there was no significant difference in survival rate among the regimens. As an adverse effect, myelosuppression and renal toxicity seemed to be dose limiting factors of CDDP combined chemotherapy for advanced prostatic cancer patients.     

Radical prostatectomy for localized prostatic cancer]

A retrospective study of 70 patients who underwent a radical prostatectomy in 1989 and 1990 was done. The significance of CT-scan in preoperative lymph node assessment should be reconsidered. The correct examination of the resection margins is very important: the pathologist should clearly distinguish between capsular invasion and capsular penetration or transgression. The etiology of local failure and its treatment are discussed.     

Clinico-morphological characteristics of latent form of prostatic cancer]

36 cases of cancer of the prostate, diagnosed at the histological study of the tissue removed during adenomectomy, have been studied. The most common from is a highly differentiated adenocarcinoma with a well developed parenchyma. Elastic consistency and smooth surface of the tumors make difficult their clinical, diagnosis. As compared to other forms of prostatic cancer, these tumors are characterized by a more favourable clinical course and prognosis.     

Acid phosphatase as tumor marker of prostatic cancer]

Prostatic cancer was the first malignancy in which tumor markers could be used to follow the response to therapy or progression of the prostate cancer. The use of these tumor markers has been of significant clinical value in diagnosis and follow-up of patients. Over the years, significant technical improvements have been made on the sensitivity and specificity of the assays for prostatic acid phosphatase.     

Results of total prostatectomy for treatment of prostatic cancer]

Between 1970 and 1989, total prostatectomy was performed in 31 patients with prostatic cancer at the Department of Urology, Tokyo Metropolitan Fuchu Hospital. These cases were composed of 4 cases of stage A, 8 cases of stage B and 19 cases of stage C. The surgical procedures were perineal prostatectomy in 25 cases, combined method of perineal and retropubic prostatectomy in 5 cases and transsacral prostatectomy in one case. Blood loss was 762 ml on the average. Blood transfusion was unnecessary in 15 cases all of whom underwent perineal prostatectomy. Endocrine or radiation therapy were administered after total prostatectomy to 23 or 13 cases, respectively. Postoperative complications included early postoperative death due to apoplexy in 1 cases, recto-vesical fistula in 1, bladder neck or urethral stricture in 9 (mild 7, severe 2) and urinary incontinence in 20 (mild 13, moderate 4, severe 3). Frequency and grade of urinary incontinence tended to become higher as the pathological stage progressed. The 5-year survival rates for clinical stage A and B, and C were 83% and 63%, respectively. We conclude that total perineal prostatectomy was less traumatic operation for prostatic cancer, and would be indicated in clinical stage A and B for radical operation and in stage C for one of the combination therapy.     

Value of PSA in the staging of prostatic cancer]

The clinical value of Serum Prostate Specific Antigen (PSA) in the staging of prostatic carcinoma was evaluated in 62 patients who underwent radical retropubic prostatectomy. Preoperative levels of PSA were compared with the final pathological stage obtained from all surgical specimens examined for capsular penetration, seminal vesical invasion and lymph node involvement. PSA level was closely correlated with the volume and the stage of the prostatic carcinoma. 93% of the patients with PSA < or = 10 ng/ml had tumor confined to the gland. All patients with PSA > 20 ng/ml had extraprostatic tumor extension (stage C or D). Patients with histologically proved prostatic carcinoma, PSA > 20 ng/ml and negative bone scan can be assumed to have extraprostatic disease and/or lymphatic involvement. Patients with PSA (drawn in the requested conditions) < or = 10 ng/ml can be considered to have organ confined disease, and can be spared a bone scintigraphy. Our study indicate an increasing role of PSA in the clinical staging of patients with prostatic carcinoma.     

The effects of mepartricin on the symptomatology of prostatic hypertrophy--double-blind controlled trial]

Seventy one patients were treated with mepartricin or placebo in three urological centres for a mean duration of 102 days (extremes: 60 and 142 days). An analysis of the results was carried out for 34 patients in the placebo group and 36 patients in the mepartricin group. The results indicate a significant improvement in both the placebo group and the mepartricin group. The irritative and obstructive symptoms are improved in the active treatment group with a response rate of the order of 70%, compared to approx. 45% in the placebo group. An improvement of the values on the flow meter, though not statistically significant, is observed following treatment with mepartricin, compared to the placebo group. There were no significant differences in the evolution of the prostate gland volume, determined by ultrasound in the placebo group and the active treatment group. Side-effects were minor and only one patient reported epigastric pain.     

Detection of early prostatic cancer in mass screening program]

Since 1975 up to 1988, we have performed a mass screening program (MS) for prostatic diseases using transrectal ultrasonography (TRS) in the primary study. In our study, 42 cases of prostatic cancer (0.6%) was detected among 6,674 examinees. Out of 42 cases of cancer, 24 (57.1%) were diagnosed as early prostatic cancer (Stage A 1, Stage B 23). The detection rate of cancer in MS and the ratio of early stage of cancer among them were higher than those in the outpatient clinic of our department. Diagnostic accuracy of TRS, palpation and tumor markers in MS were studied respectively through our series of MS. TRS was useful for MS especially in low false negative rate. On the other hand, palpation was characteristic in low false positive rate. Prostatic specific antigen (PSA) among tumor markers was effective to detect early prostatic cancer. However, there were some problems about distinguishing early prostatic cancer from BPH, because of the high false positive rate.     

Clinical effects of estramustine phosphate disodium (Estracyt) on prostatic cancer

Estramustine phosphate disodium (Estracyt) was used in the treatment of 40 patients with prostatic carcinoma. Of these 20 patients 18 were treated with Estracyt as primary treatment and 22 had been treated with diethyl stilbestrol dephosphate and/or bilateral orchiectomy for more than 4 months before the Estracyt treatment. The drug was given orally in a dose of 560 mg/day in 2 divided oral doses. The clinical evaluation was done after 3 months treatment. The response in subjective symptoms and objective signs were documented and evaluated according to 5 criteria. In this study, Estracyt showed 80% improvement of dysuria, 60% of nykturia, 35% of pain and 55% of general condition. In objective signs, it showed 52.5% improvement of size of the prostate, 42.5% of consistency and 70% of residual urine. It would be emphasized that Estracyt had almost equal efficacy in both the primary treatment group and secondary treatment group. As side effects of this drug, gynecomastia, gastro-intestinal disturbance, angina pectoris like chest pain were observed.     

Histological determinants of the vascular surface in prostatic carcinoma

This study was performed to analyse the correlation between vascular surface (VS), tumour grade and stage and relative proportion of tumour cells within the tumour stroma. Specimens of 41 prostatic carcinoma were immunostained using Factor VIII-related antigen. The VS was assessed by means of stereology. In tumour-free prostatic tissue the VS was 6.7 ± 0.4 mm^–1. In pT2 tumours this value was significantly increased to about 12 mm^–1. With rising pT stage the VS significantly decreased to values of 4 in pT4 tumours. In G1 tumours the VS was 14.6 mm^–1 and significantly decreased with decreasing grade of differentiation. No significant difference was obtained between pN0 and pN + cases. A close positive correlation (r = 0.59,P < 0.001) existed between the VS and the relative proportion of tumour cells within the tumour, whereas a strong negative correlation was found between the VS and the relative amount of tumour stroma (r = 0.81,P < 0.001). The VS mainly depends on tumour differentiation and pT stage, i.e. the tumour size and the relative proportion of stroma and tumour cells within the tumour. These results are consistent with those obtained in experimental tumours. Assessment of the VS is therefore of interest in studies of tumour biology; it is of no use in predicting lymph node metastasis.     

Clinical and pathological study of tumor marker in benign prostatic hypertrophy and incidental prostatic cancer]

To determine the value of prostatic markers for prostate cancer, serum prostatic acid phosphatase (PAP), prostate specific antigen (PSA) and gamma-Seminoprotein (gamma-Sm) were measured in 81 patients with benign prostatic hypertrophy and in 12 patients with incidental prostatic cancer. gamma-Sm was the most sensitive but the least specific of the three markers. Large prostate glands, especially hyper-glandular type tended to be associated with high gamma-Sm levels in our study. Patients with acute urinary retention, acute prostatitis and necrosis also showed positive markers. Out of 12 patients with incidental cancer, 5 patients had more than 2 elevated markers. Four patients with poorly differentiated adenocarcinoma failed to show increased markers.     

Clinical and pathological study of 152 cases of prostatic cancer]

A total of 152 prostatic cancer patients who underwent mainly hormone therapy was conducted. Our histological grading system combined with structure atypsim--SAT and nuclear anaplasia--NAN allowed for more accurate prognosis of prostatic cancer patients. The prognosis of G3 patients was obviously poor. The over-all 5-year survival rate for prostatic cancer patients with G1, G2 and G3 was 80%, 57% and 17%, respectively. The 5-year reactivation rate for patients with G1, G2 and G3 was 14%, 32% and 87%, respectively. The period for reactivation after initial hormone therapy for prostatic cancer patients with G1, G2 and G3 was 11.4, 10.0 and 3.2 years, respectively. Further improvements in survival for the patients with G3 prostatic cancer will require the development of effective systemic chemotherapy and the re-consideration of appropriate use of hormone therapy.     

Relationship between reactivation and tumor markers in prostatic cancer]

Twenty-seven cases of reactivated prostatic cancer between 1979 and 1990 were investigated. Reactivation took place in the form of local aggravation in 3 cases, occurrence or aggravation of metastasis to bones in 8 cases, and in both forms in 16 cases. The elevation of tumor markers preceded the clinical findings in 11 cases (41%). In 75% of the cases with occurrence or aggravation of metastasis, the elevation of tumor markers preceded the clinical findings. This showed that tumor markers were useful in most cases for early detection of reactivation. However, in 3 cases with local aggravation, the clinical findings preceded the elevation of tumor marks. Therefore, it is also important to check the clinical findings at the follow-up. At the time of reactivation, positive rates of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostatic specific antigen (PA) were 78%, 83% and 80%, respectively. Thus gamma-Sm and PA appeared to be more reliable than PAP for monitoring of prostatic cancer.     

Prostatic cancer after transurethral resection for benign prostatic hypertrophy]

Five cases of prostatic cancer developed after transurethral resection of prostate for benign hypertrophy are reported. Duration of transurethral resection of prostate (TUR-P) to diagnosis of prostatic cancer ranged from one year and seven months to seven years and two months, on average four years and seven months and frequency of prostatic cancer after TUR-P was estimated at 1.2%. Four of five patients complained of macroscopic hematuria. The cystourethrogram showed the mass protruded in the dilated prostatic urethra or bladder-neck in four patients (80%), a remarkable finding, and four cases were at stage D. Risk of development of prostatic cancer is not decreased even after prostatectomy and prostatic carcinoma diagnosed after TUR-P often advances in stage. Therefore, periodical examinations of the patients who had a prior prostatectomy are very important.