Importanza dei criteri di selezione nei pazienti sottoposti a terapia ormonale neoadiuvante e prostatectomia radicale per carcinoma prostatico * : Selection criteria for patients undergoing neoadjuvant hormonal therapy and radical prostatectomy for prostate cancer

Abstract

From April 1989 until December 1993, 73 prostatic cancer patients underwent radical retropubic prostatectomy; 27 among the above-mentioned patients, mean age 65 years, mean follow-up 17.4 months, were treated with total androgen blockade for a period of 6 months before radical surgery. Selection criteria were: clinically locally advanced disease, high PSA levels and Gleason score ≥ 4. Stage reduction (downstaging), PSA variations, grade alterations (downgrading) and influence of DNA ploidy on recurrences has been evaluated. Overall downstaging has been 30%. In C2-D1 stages the effects of hormonal treatment have been particularly significant: only 12 of the 17 clinical C2 tumours where confirmed at pathological examination and of the 4 D1 cases, only one showed pathological involvement of the lymph nodes. PSA regression to undetectable levels has been noted in 48% of patients; preoperatively 46% of cases presented PSA levels > 10 ng/ml while the same held true for only 14.5% of patients at surgery. The so-called downgrading has been of marginal entity in our series. Nuclear ploidy seems to play a major role in disease-free survival. Aneuploid DNA content conferred a significantly higher risk of local and distant relapses in all stages. Nuclear aneuploidy also correlates well with lower PSA production.