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

Spanish

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.

Keywords

terapia ormonale neoadiuvante prostatectomia radicale carcinoma prostatico neoadjuvant hormonal therapy radical prostatectomy prostate cancer

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