The role of neoadjuvant hormonal manipulation in localized prostatic cancer.
BACKGROUND
Although hormonal manipulation is standard therapy for patients with metastatic prostatic cancer, its use in localized disease in combination with surgical extirpation of the gland has not been investigated thoroughly and systematically.


METHODS
The authors report their initial pilot studies using preoperative neoadjuvant endocrine therapy.


RESULTS
Although marked reduction in serum prostate-specific antigen (PSA) levels occurred in all patients, the PSA level after endocrine manipulation did not predict the pathologic stage. In addition, immunohistochemical staining of the radical prostatectomy specimen for PSA, in several patients with a zero serum PSA level, after endocrine therapy revealed intense PSA staining in the cancer cells but not in benign epithelium. The effects on tumor downstaging were inconclusive. Overall, only 33% of patients had organ-confined disease, but in some patients, complete tumor regression (PO) occurred.


CONCLUSIONS
Neoadjuvant hormonal therapy in prostatic cancer, although definitely not standard therapy, bears investigation. In addition to the effect on the "index" cancer, it also provides an opportunity to evaluate the effect of hormonal agents on microfocal ("early") cancer and known precursors of malignant change. Therefore, it may provide a means of assessing agents of potential use in the development of chemopreventive strategies.
Fair
W R
WR
Memorial Sloan Kettering Cancer Center, New York, NY 10021.
Aprikian
A
A
Sogani
P
P
Reuter
V
V
Whitmore
W F
WF
D000284:Administration, Oral; D000818:Animals; D001706:Biopsy; D003131:Combined Modality Therapy; D004054:Diethylstilbestrol / Q000008:administration & dosage*; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005834:Genital Neoplasms, Male / Q000556:secondary; D006801:Humans; D008297:Male; D008325:Mammary Neoplasms, Experimental / Q000628:therapy; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009919:Orchiectomy; D010865:Pilot Projects; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012669:Seminal Vesicles; D012737:Sex Factors
D004967:Estrogens; D004054:Diethylstilbestrol; D017430:Prostate-Specific Antigen