125I 粒子植入联合最大限度雄激素阻断治疗高危前列腺癌

目的：探讨 ¹²⁵I 放射性粒子植入联合最大限度雄激素阻断治疗高危前列腺癌的临床效果。方法：78 例高危前列腺癌患者，全身麻醉，截石位，经直肠超声勾画前列腺轮廓，计算机制定植入计划，经会阴 ¹²⁵I 放射性粒子依次植入，术后继续全雄激素阻断治疗 18 个月停止内分泌治疗，后每三月复查 PSA， PSA 连续 3 次上升≥ 2 ng/mL 或至原来底限的 2 倍，则重新开始内分泌治疗。结果：所有患者手术均顺利，植入粒子 41 ～ 94 粒，平均 69 粒。术后随访 18 ～ 54 个月，平均 35 月。术后 18 月内分泌治疗结束 56 例患者 PSA 降到 0.02 ng/mL 以下，18 例 PSA 未达到 0.02 ng/mL 以下，4 例患者出现 PSA 反弹；术后 27 月 1 例发生多发骨转移死亡；术后 39 月 3 例出现 PSA 反弹，再次全雄激素阻断内分泌治疗 3 个月 PSA 值下降到治疗时低值，目前随访中 53 例 PSA 在 0.02 ng/mL 以下，继续密切监测 PSA 及全身状况随诊观察。结论： ¹²⁵I 粒子植入联合术后全雄激素阻断内分泌治疗是治疗高危前列腺癌的一种微创、可供高危前列腺癌选择的有效方法。     

腹腔镜前列腺癌根治术联合辅助疗法治疗高危前列腺癌的早期效果分析

目的探讨腹腔镜前列腺癌根治术联合辅助疗法治疗高危前列腺癌的早期效果。方法回顾性分析2013年6月至2017年9月安徽医科大学第二附属医院收治的69例行根治性手术联合辅助治疗的高危前列腺癌患者,根据治疗方式不同分为腹腔镜前列腺癌根治术联合术后长期内分泌治疗(RP+AHT)组37例,术前新辅助内分泌治疗加上腹腔镜前列腺癌根治术及术后再行内分泌治疗组(NHT+RP+AHT)21例,术前行新辅助化疗联合雄激素剥夺治疗加上腹腔镜前列腺癌根治术及术后再行内分泌治疗(NCHT+RP+AHT)组11例。比较三组PSA无进展生存期、术后病理切缘阳性、并发症发生和尿控恢复情况,术前新辅助治疗后的病理改变。结果 PSA无进展生存期、术后病理切缘阳性例数、术后并发症发生情况及术后尿控恢复情况三组无差别(P0.05)。NHT+RP+AHT组术后病理变化示:1例微小残留灶(少量癌细胞及大量泡沫细胞),1例术前穿刺Gleason评分4+4分术后为4+3分,其它未见明显变化,NCHT+RP+AHT组术后病理变化示:2例术后病理完全缓解(大量泡沫细胞未见癌细胞),2例微小残留灶,余7例病理未见明显变化。结论高危前列腺癌术前是否行新辅助治疗在PSA无进展生存期、病理切缘阳性、并发症及尿控恢复无明显差别,但术前新辅助治疗为患者提供手术机会,改善术后病理,为后期治疗提供帮助,术后即刻及长程的内分泌治疗有助于控制疾病进展。     

新辅助内分泌治疗联合腹腔镜根治性前列腺切除术治疗高危前列腺癌体会

目的 探讨先行新辅助内分泌治疗后行腹腔镜前列腺癌根治术治疗高危前列腺癌的可行性及效果.方法 收集2013年10月至2016年1月本院先行新辅助内分泌治疗后,再行腹腔镜根治性前列腺切除术治疗14例高危前列腺癌患者的临床资料,术前病检诊断明确,完成Gleason评分,MRI增强扫描完成临床分期,行骨扫描及相关辅助检查排除远处转移,术前辅助内分泌治疗3～6个月控制PSA＜4μg/L后行腹腔镜根治性前列腺切除术,术后观察患者排尿情况及PSA控制情况等.结果 大部分患者手术时间为130～290 min,无输血、无直肠穿孔患者,术后平均15 d拔除尿管,术后3个月均能自行控尿,术后3例病检切缘阳性,术后3个月复查PSA＜0.2μg/L.结论 高危前列腺癌患者经内分泌治疗后行腹腔镜根治性前列腺切除术是安全可行,但术前需充分评估风险及并发症情况.     

前列腺黏液腺癌2例报告并文献复习

目的:总结前列腺黏液腺癌(mucinous adenocarcinoma,MC)的临床病理特点、治疗方法及预后。方法:回顾性分析2002年1月~2014年10月收治的2例前列腺MC患者的临床病理资料:年龄分别为82和73岁,因排尿困难入院,tPSA分别为15.59ng/ml和210.1ng/ml,术前CT或MRI检查未见前列腺癌表现。1例行TURP术,术后行全雄激素阻断治疗;1例行前列腺穿刺活检确诊后行新辅助内分泌治疗3个月,然后行腹腔镜下前列腺癌根治术,术后部分切缘阳性,行辅助内分泌治疗及辅助放疗。结果:1例随访4年,排尿通畅,未见肿瘤转移。1例随访19个月,未见局部复发及转移。结论:前列腺MC临床罕见,病理学及免疫组织化学检查为确诊手段;内分泌治疗有效,根治性手术预后与普通前列腺癌类似。     

经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌

目的 探讨经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌的临床意义.方法 采用经尿道前列腺等离子切除术、去势术以及间歇雄激素阻断等综合方法治疗合并膀胱出口梗阻的晚期高危前列腺癌患者14例.结果 所有手术均成功施行.术前及术后3个月复查尿动力学指标,患者最大尿流率由(8.0±3.2)ml/s上升为(1...     

地加瑞克联合阿帕他胺用于极高危前列腺癌新辅助治疗1例报道

探讨极高危前列腺癌(very high-risk prostate cancer,VHRPCa)采用新型内分泌药物新辅助治疗后给予根治性前列腺切除术(radical prostatectomy,RP)的疗效。患者男,61岁,因“进行性排尿困难,夜尿增多4年,加重半年”就诊。总前列腺特异性抗原(total prostate specific antigen,tPSA) 89.16μg/ml。磁共振成像示前列腺大小5.2 cm×4.6 cm×4.2 cm,右侧外周带前列腺癌累及中央带;直肠受侵,前列腺影像报告和数据评分系统评分为5分;膀胱左后方及上方多发淋巴结增大。穿刺活检示前列腺癌,Gleason评分5+5=10分;骨扫描未见明显异常。采用新型内分泌药物阿帕他胺+地加瑞克新辅助治疗9个月后复查tPSA为0.05μg/ml;磁共振成像见前列腺体积缩小。给予RP+盆腔淋巴结清扫,术中粘连明显,平面欠清晰。术后病理Gleason评分5+4=9分,切缘和淋巴结均为阴性。术后维持原新辅助方案继续辅助治疗1年后,tPSA为0μg/ml;磁共振成像和发射型计算机断层扫描成像未见异常,故改为单纯雄激素剥...     

前列腺癌根治术后反复膀胱尿道吻合口狭窄1例报告

患者,男,68岁,2014年5月因"排尿困难半年"入院.有高血压病史.直肠指诊:前列腺Ⅲ度增大,左侧叶可扪及质硬结节.TPSA 53.660ng/ml.盆腔磁共振检查:前列腺左侧外周带异常信号影,前列腺包膜不连续,考虑前列腺癌可能性大,未见盆腔淋巴结及骨转移.行经直肠超声引导下13针前列腺系统穿刺活检术,病理示前列腺腺癌,Gleason评分:4+4=8分,8/13针阳性.全身骨扫描未发现骨转移.行新辅助内分泌治疗(全雄阻断)4个月,复查TPSA,下降至0.003ng/ml.     

经尿道前列腺等离子汽化电切联合间断雄激素阻断治疗晚期前列腺癌

目的:探讨经尿道前列腺电切术联合间断雄激素阻断治疗前列腺癌的临床疗效。方法:回顾分析我院为24例确诊为合并膀胱出口梗阻晚期前列腺癌患者行经尿道前列腺等离子汽化加全间断雄激素阻断术的临床资料。结果:24例手术均获成功,术中出血少,术后随访12个月,术后3个月国际前列腺症状评分(7.12±4.24),生活质量评分(1.8±0.4),残余尿(26.5±12.2)ml,最大尿流率(17.82±2.78)ml/s,血清PSA平均(6.3±2.1)ng/ml。结论:等离子汽化电切加间断雄激素阻断治疗能提高合并膀胱出口梗阻晚期前列腺癌患者的生存质量。     

低血清PSA型前列腺癌的回顾性研究

目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。     

前列腺癌的间歇内分泌治疗

1941年，Huggins和Hodges发表了获得诺贝尔奖的有关雄激素去除对晚期前列腺癌作用的研究，开创了前列腺癌内分泌治疗的先河。前列腺癌的内分泌治疗包括联合内分泌治疗（CAB）、单独去势治疗、新辅助内分泌治疗（NHT）、辅助内分泌治疗（AHT）及间歇内分泌治疗（1AD）等，而前列腺癌经内分泌治疗后由激素依赖性转变为非激素依赖性，最终转化为激素不敏感性肿瘤，是前列腺癌患者癌特异性死亡的原因。近年来研究表明完全雄激素阻断并不能延长前列腺癌细胞进展到非雄激素依赖的时间，同时完全雄激素阻断带来患者生活质量的下降，如性欲低下，勃起功能障碍，疲劳，智力下降，心理障碍-精神抑郁，肌力降低，脂肪聚积，生理活动和整体活动能力降低，同时增加了患者的相关治疗费用。     

Pretreatment prostate specific antigen (PSA) and 2-year PSA dynamics: Early predictors of prostate cancer prognosis with external radiation therapy

IntroductionThe dynamics of prostate specific antigen (PSA) in patients who have prostate cancer and receive radiotherapy is a very interesting but complicated topic. We tried to plot the sequential changes of PSA with and without hormone therapy and tried to find out the predictors for the high-risk patients for prostate cancer recurrence.MethodsWe reviewed the medical records of 164 prostate cancer patients who underwent intensity-modulated radiation therapy (IMRT) as the primary treatment. We recorded the patients' age, initial PSA, cancer grading at diagnostic biopsies (Gleason's score), clinical stage, the IMRT dosage, neoadjuvant, concomitant, and prolonged hormone therapy, follow-up PSA levels, biochemical progression, and distant metastasis.ResultsOf the 84 patients undergoing radiotherapy for prostate cancer with complete data for analysis, the biochemical failure-free survival (BFFS) rate was 88.09%. The patients with an initial PSA of less than 10 ng/mL had the best BFFS. Of the patients receiving neoadjuvant hormone therapy (NHT), serum PSA levels were significantly higher in those with biochemical failure than those without biochemical failure in the 3 months after radiation therapy. As for the patients free of biochemical failure, the mean PSA fell below 1 ng/mL immediately after IMRT for the NHT(+) group and at 9 months after IMRT for the NHT(–) group.ConclusionFor the patients with localized prostate cancer who underwent IMRT, initial PSA could predict clinical stage, 1-year BFFS, and 2-year BFFS. The follow-up PSA, as early as 3 months, was of clinical predictive value.     

Reliability of preoperative values to determine the need for lymphadenectomy in patients with prostate cancer and meticulous lymph node dissection

INTRODUCTION: The only definite way to determine lymph node metastasis, an unfavorable prognostic factor in prostate cancer is lymphadenectomy. Due to increased morbidity and the increasing trend towards minimally invasive surgery, ways to avoid or at least limit lymphadenectomy are being sought. We routinely performed a meticulous lymphadenectomy in all patients and the goal of this study was to evaluate which of the previously proposed criteria determining who needs a lymphadenectomy can be applied in our patients.PATIENTS AND METHODS: Patients with clinically localized prostate cancer confirmed by fine needle aspiration cytology, without neoadjuvant hormone therapy, negative pelvic and abdominal CT scans and negative bone scan underwent a radical prostatectomy with simultaneous bilateral extended lymphadenectomy.RESULTS: Between 1989 and 1999, 463 patients were included in this study. The median age was 64 (range 44-76) years and the median PSA was 11.0 (range 0.42-172) ng/ml. A median of 21 nodes were removed per patient. One hundred and nine (24%) had lymph node metastasis: 17% of patients with a PSA value < or =20 ng/ml and 12% with a PSA value < or = 10 ng/ml. None of the patients with a preoperative grading of 1 and a PSA value < or =10 ng/ml and 10% of the "low-risk patients" with a PSA value < or = 10 ng/ml and a preoperative grading <3 had lymph node metastases. Seven percent with a PSA value < or = 10 ng/ml and a prostatectomy Gleason score under 7 were found to be node positive.CONCLUSIONS: A significant number of patients would have been understaged and left with diseased nodes when applying preoperative PSA value < or = 10 ng/ml and grading <3/Gleason <7 as criteria for omitting lymphadenectomy. Therefore we consider meticulous lymphadenectomy a must for correct staging in all patients undergoing radical prostatectomy for prostate cancer, with the exception of patients with a grading of 1 and a PSA < or = 10 ng/ml.     

A case of locally advanced prostate cancer with low serum testosterone associated with intake of an androgenic medicine

A 74-year-old man was referred to our clinic for the work-up of digitally hard and irregularly surfaced prostate and elevated serum prostate-specific antigen (PSA). His serum PSA was elevated to 41 ng/ml, but testosterone and LH level were decreased to 23.5 ng/dl and 0.5 mIU/ml, respectively. He had a history of taking an androgenic medicine containing methyl-testosterone 2 to 3 times a week for 2 year and 6 months. Transrectal sextant prostatic biopsy revealed moderately differentiated adenocarcinoma (Gleason score: 3 + 4) in 6 of 6 specimens and CT scan of the abdomen showed an enlarged obturator lymph-node (15 mm), resulting in the diagnosis of stage D1 (T3aN1M0) prostate cancer. Since serum testosterone level seemed to recover around the normal level after discontinuation of the exogenous androgen, we treated him with combination androgen blockade with LHRH agonist and bicaltamide, although his testosterone level was very low. Indeed, serum PSA decreased to 0.09 ng/ml and the right obturator node was markedly reduced by the hormone treatment. After the neoadjuvant therapy of 6 months duration, radical prostatectomy and limited pelvic lymph node dissection was carried out. Histologically, viable cancer cells were not found in any of resected lymph nodes, but they remained in bilateral lobes of the prostate (pT2bN0). The histological effect of the neoadjuvant hormone therapy according to General rule for Clinical and Pathological Studies on Prostate Cancer (3rd ed.) was grade 2. The patient has been well with undetectable PSA and no evidence of clinical failure for more than 12 months, though serum testosterone level recovered to near normal (288 ng/dl) 8 months after the cessation of the hormone treatment following the operation. Combination androgen blockade or non-steroidal anti-androgen agent appears to be effective for the treatment of prostatic cancer patients who takes exogenous androgenic medicine, even with a suppressed low serum testosterone level.     

Prognostic significance of the nadir prostate specific antigen level after hormone therapy for prostate cancer

PURPOSE: We determine whether the nadir prostate specific antigen (PSA) level after hormone therapy can be used to predict the progression to hormone refractory prostate cancer. MATERIALS AND METHODS: We reviewed the progressive status and survival of 177 patients with stage C or D prostate cancer who had received hormone therapy at our institution. The overall survival rate, incidence of progression to hormone refractory prostate cancer and interval until progression were analyzed with reference to the nadir PSA level. Multiple regression analysis was used to analyze the predictive factors for progression to hormone refractory prostate cancer, and the relative efficacy of the nadir PSA level in predicting progression was evaluated by receiver operating characteristics analysis. RESULTS: Median followup was 39 months (range 3 to 89) and 85.4% of patients (151) responded to treatment, of whom 77.5% (117) had progression to hormone refractory prostate cancer. Median time until nadir PSA levels were reached after hormone therapy was 8.1 months and median time until hormone refractory prostate cancer was 24.0 months. Nadir PSA levels were less than 0.2 ng./ml. in 31% of respondents, 0.2 to 1.0 ng./ml. in 23%, 1.1 to 10 ng./ml. in 42% and greater than 10 ng./ml. in 5%. These groups had similar clinicopathological characteristics. Nadir PSA levels correlated significantly with pretreatment PSA levels, Gleason scores and progression to hormone refractory prostate cancer (p = 0.01, p <0.01 and p <0.001, respectively), and inversely correlated with the interval to the establishment of hormone refractory prostate cancer (r = -0.465, p <0.05). By univariate analysis bone metastasis, nadir PSA, PSA at 6 months after treatment and pretreatment PSA were significantly associated with progression to hormone refractory prostate cancer. Only the nadir PSA was calculated to be an independent factor by multivariate analysis. Receiver operating characteristics analysis indicated that nadir PSA predicted progression to hormone refractory prostate cancer after 2 years with an accuracy of 86.2%. With the lower limit of the nadir PSA level set to 1.1 ng./ml., sensitivity was 80.3% and specificity was 83.8%, and these levels were deemed the most appropriate. Furthermore, nadir PSA after hormone therapy was an independent prognosticator for survival, as were initial levels of hemoglobin and alkaline phosphatase. CONCLUSIONS: The nadir PSA level after hormone therapy may be the most accurate factor predicting the progression to hormone refractory prostate cancer and is an independent prognostic factor for survival. Furthermore, a lower limit for the nadir PSA level of 1.1 ng./ml. gives optimal sensitivity and specificity.     

8-month neoadjuvant hormonal therapy before radical prostatectomy for high-risk prostate cancer

PURPOSE: To evaluate the clinicopathological outcomes of 8 months of neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy for high-risk prostate cancer. PATIENTS AND METHODS: A multi-institutional prospective trial was performed between July 2000 and May 2003 involving high-risk prostate cancer patients without metastasis, including 21 who received 8 months of NHT before radical prostatectomy. High-risk group was defined as clinical stage > or =T2c and/or prostate-specific antigen (PSA) >20 ng/ml and/or Gleason score > or =8. PSA values were considered elevated (biochemical failure) if values of 0.1 ng/ml or greater were obtained. RESULTS: Median of initial PSA levels before prostate biopsy was 27.6 ng/ml (8.5-80.7 ng/ml), and median of pre-operative PSA levels after NHT was 0.28 ng/ml (0.02-4.2 ng/ml). There were 5 patients (23.8%) with lower limit of PSA detection (less than 0.02 ng/ml) in 8 months after NHT. The clinical T stage was T1c in 9 patients (42.9%), T2a-b in 8 patients (38.1%), T2c in 3 patients (14.3%), and T3a in 1 patient (4.8%). The median follow-up was 25 months (range 4 to 37). There were 2 patients (9.5%) in pT0, 5 patients (23.8%) with positive surgical margin, 5 patients (23.8%) with extracapsular extension (ECE) and 3 patients (14.3%) with seminal vesicle involvement (SVI). Biochemical failure was occurred in 9 of 21 (42.9%) including of one pT0. Range of time to postoperative biochemical failure was 2 to 25 months (median 6 months) and most of biochemical failure was found within 12 months after surgery. Biochemical failure rate was significantly higher in patient with positive SVI (p = 0.0308) and higher in patients with pre-operative PSA levels of more than 0.1 ng/ml (p = 0.0836), positive ECE (p = 0.0545) and positive surgical margin (p = 0.0545). CONCLUSION: Biochemical failure was frequent after this combined treatment, even in a pT0 case. Long-term follow-up of patients is needed to assess the impact of this therapy on mortality.     

Global update on defining and treating high-risk localized prostate cancer with leuprorelin: a European perspective

High-risk prostate cancer can be defined as a cancer that, although clinically localized, will not be cured by monotherapy, whether surgery or radiation, and as a result will require some form of multimodal therapy, which will normally include luteinizing hormone-releasing hormone agonists. High-risk localized prostate cancer can be identified at three specific points during the management of the patient; before starting treatment (based on the profile of some predictive criteria, e.g. pathological features, prostate-specific antigen, PSA, level, and PSA velocity), on pathological evaluation of a surgical specimen taken during radical prostatectomy, or at the point of PSA relapse after radiotherapy or surgical therapy. Within Europe, therapeutic choice in patients identified as high-risk is normally made based on their age and life-expectancy. In those with a relatively long life-expectancy (>10 years) androgen suppression therapy (AST) should form part of a multimodal approach to treatment, but neoadjuvant hormonal therapy should be limited to use in combined hormonal therapy/radiotherapy protocols. AST can also be used to treat patients with PSA relapse. Several studies investigated the relative advantages of giving AST continuously vs intermittent therapy, but there are no notable differences between these approaches. AST monotherapy can be indicated in those patients with a shorter life-expectancy (<10 years), particularly if there are poor risk factors, e.g. a high PSA level (>50 ng/mL) or a short PSA doubling time (<12 months).     

Three dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer under field adjustment with implanted gold markers: early clinical outcome

Three dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer under field adjustment with gold marker implantation was performed according to the treatment strategy based on the clinical risk factors to the patients who chose external beam radiotherapy. The treatment strategy contains indications for laparoscopic staging lymphadenectomy and neoadjuvant combined androgen blockade (CAB). This protocol was applied to 19 patients at Kagawa University Hospital from July 2001 to December 2003. The patients were divided into high-risk group (n=14): T3-4N0M0 or PSA > or = 20 ng/ml or Gleason sum > or = 8 or suspicious node, and low-risk group (n=5): T1c-2bN0M0 and PSA < 20 ng/ml and Gleason sum < or = 7 and no suspicious nodes. Basically, high-risk patients underwent laparoscopic staging lymphadenectomy prior to radiotherapy. One of the 14 patients had a positive node and underwent endocrine therapy. The high-risk group received neoadjuvant CAB for 3 to 4 months, followed by gold marker implantation. One patient chose endocrine therapy at this point. Low-risk patients underwent marker implantation without endocrine therapy. Every patient successfully completed planned irradiation. The changes of prostate volume and serum PSA after neoadjuvant CAB were significant [28.7 ml to 15.7 ml (p=0.004) and 53.9 ng/ml to 1.4 ng/ml (p=0.023), respectively]. Only one patient in the high-risk group had biochemical failure. No grade 3 or 4 adverse events occurred in NCI-CTC grading. The analysis of gravity center migration of the implanted gold markers in the first 8 patients showed that the planned safety margin might not be wide enough to avoid neighboring organ irradiation. These results suggested that 3D-CRT under field adjustment with implanted gold markers contributes to both higher efficacy and lower morbidity.     

Long-term results of neoadjuvant hormonal therapy prior to radical prostatectomy in patients with clinically localized prostate cancer: biochemical and pathological effects

The objective of this study was to evaluate the long-term biochemical and pathological effects induced by neoadjuvant hormonal therapy (NHT) in patients with clinically localized disease. Between March 1993 and May 1997, 24 patients with clinically localized prostate cancer received NHT for 3 to 11 months (median: 5 months) using luteinizing hormone-releasing hormone analogue prior to radical prostatectomy and pelvic lymphadenectomy. The clinical stage was T1 in 1 patient, T2 in 17 and T3 in 6, the pretreatment serum prostate-specific antigen (PSA) value was < or = 10 ng/ml in 5 patients, 10 to 20 ng/ml in 4 and > 20 ng/ml in 15 (mean: 34.7 micrograms/l), and the Gleason score was < or = 4 in 9 patients, 5 to 7 in 11 and > 8 in 3. The mean prostate specific antigen (PSA) value 3 months after NHT had reduced below 2 ng/ml in 18 of the 24 patients (67%), and finally decreased by an average of 95% (i.e., 1.9 ng/ml) prior to surgery. The pathological stage was pT0 in 2 patients, pT2 in 10 and pT3 in 12. The incidence of organ-confined disease (OCD) was significantly higher in patients with clinical stage T1 or T2a than with T2b or T3, with pretreatment PSA values < or = 10 ng/ml than with PSA values > 10 ng/ml, and with PSA values < or = 2 than with PSA values > 2 at 3 months after NHT; in contrast, the Gleason score had no significant impact on the rate of OCD. After a median follow-up of 49 months (range 34 to 85 months), 6 patients (25%) had a recurrence evidenced by rising PSA, and the 3-year recurrence-free survival rate was 79%. These results suggest that NHT appears not to be of significant additional benefit to patients who have a higher clinical T stage, higher pretreatment PSA values and/or in patients whose PSA values do not normalize early in the treatment process.     

A survey of radical surgery without neoadjuvant therapy for patients with stage B and C prostatic carcinoma

There has been much controversy regarding radical surgery for both localized and locally extensive carcinoma of the prostate. We analyzed the outcome of radical prostatectomy and the preoperative evaluation in order to assess the indication of radical prostatectomy. Fifty-six patients with clinical stage B or C prostate cancer were treated by radical prostatectomy without neoadjuvant therapy. Endocrine therapy was added to the non-curative cases postoperatively. Preoperative evaluation was compared with pathological results and survival, and furthermore the usefulness of the preoperative PSA and PSA half-life were investigated. The mean follow-up period was 44.5 months. The accuracy of the grade and the clinical stage were 58.9% and 23.2%, respectively. Organ-confined disease was seen in patients with an initial PSA level less than 30 ng/ml. Postoperative PSA half-life is significantly prolonged in cases with poorly differentiated adenocarcinoma or lymph node involvement and may be a predictor of PSA failure. The cause-specific 5-year survival rates were 92.7% on the whole, 92.9% for well differentiated, 96.7% for moderately differentiated, 85.7% for poorly differentiated, 100% for stage B1, 95.0% for stage B2 and 86.8% for stage C. These results indicated that patients with an initial PSA level of less than 30 ng/ml will benefit from radical prostatectomy.