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

Abstract

限局性前立腺癌と診断し, 術前内分泌療法に引き続き根治的前立腺全摘術を施行した24例で臨床病理学的検討を行った.LH-RHアゴニストによる3ヵ月間の術前内分泌療法施行後, 24例中22例でPSAが2μg/l以下に低下, 術前には治療前平均値の約5%に低下した.臨床病期がT2a以下, 治療前PSAが10μg/l以下, 或いは内分泌療法施行3ヵ月後のPSAが2μg/L以下の症例では, 病理学的にもpT2以下であることが多かったが, Gleason scoreとは相関しなかった.術後PSA failureを6例に認め, 3年非再発率は79%であった(観察期間の中央値:49ヵ月)が, 非再発率と病理学的病期との間に相関はなかった.以上より, 臨床病期がT2b以上, 治療前PSA値が10μg/lを超える, 或いは内分泌療法施行3ヵ月後のPSA値が正常化しない症例では, 術前内分泌療法を施行しても病理学的にpT3以上である可能性が高い

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 20 ng/ml in 15 (mean: 34.7 micrograms/l), and the Gleason score was 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 10 ng/ml, and 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.