Stage B2, C 前立腺癌に対する術前内分泌療法の有用性

Abstract

40例のlocally advanced diseaseに対してneoadjuvantとして内分泌療法を施行後に前立腺全摘除術を施行した. 1)被膜外浸潤, 精嚢浸潤, 切除断端陽性率及びリンパ節転移はhistorical controlと比較しいずれも低かった. 2)病理組織学的効果は, 43%に良好な効果が得られたが, 30%の症例では殆ど認められず, 又, これらの症例ではKi67による免疫組織染色上増殖能が高かった. 3)Neoadjuvant後のPSA値が低値であることが, organ confined diseaseへの必要条件と思われた. 4)ApoptosisとKi67の発現は反比例の関係にある. 5)観察期間の中央値が50ヵ月で40例中4例にのみ再発再燃を認め, 早期癌の治療成績に匹敵する結果となった

Recently, there has been an increasing interest in the application of preoperative endocrine therapy prior to radical prostatectomy. The main purpose of this treatment modality is to enhance surgical curability and increase survival. Endocrine therapy was performed before radical prostatectomy on 40 patients between 1986 and 1993; 15 had stage B2 and 25 had stage C disease. The median duration of preoperative endocrine therapy was 3.8 months. All patients subsequently underwent radical prostatectomy, pelvic lymphadenectomy and castration. There was on average a 25.5% (0-71.8%) decrease in maximal cross-sectional area of prostate gland as determined by transrectal ultrasonography. Treatment-related histological effects, divided into three grades were as follows; excellent in 17, moderate in 11 and poor or no regression in 12. Pathological downstaging of disease status from the diagnosis made at the initial clinical examination was seen in 13 of the 40 patients (33%). At a median follow-up of 50 months (19-118 months), 36 of the 40 patients are disease-free and two died of cancer 43 and 50 months postoperatively. These findings suggest that preoperative endocrine therapy plays an important role in the management of locally advanced prostatic cancer.