Effects of neoadjuvant androgen deprivation therapy on prostatic cancer.
OBJECTIVE
In this study, we analyzed the involutive effects of androgen deprivation therapy on normal and neoplastic prostatic tissue, to investigate whether androgen deprivation prior to radical prostatectomy could reduce the incidence of extracapsular extension, positive margins, positive seminal vesicles and positive lymph nodes in patients with prostatic carcinoma.


METHODS
We performed neoadjuvant androgen deprivation therapy (NADT) in 41 patients cT2N0M0 and in 21 patients cT3N0M0. Criteria to evaluate the effectiveness of NADT included prostate volume, tumor volume, serum prostate-specific antigen (PSA), staging, grading, histological modifications of the tumor, and evaluation of indices of cellular proliferation.


RESULTS
We observed a decrease in prostate and tumor volume, as well as serum PSA; a down-staging effect was observed in 14.51% of cases. Evaluation of proliferating-cell nuclear antigen (PCNA) revealed a decrease of proliferative activity in treated prostatic carcinoma. The histological modifications after neoadjuvant therapy consisted of cellular necrosis with apoptotic phenomena, dense chromatin without nucleoli, absence of mitosis, inflammatory infiltrate, and interstitial fibrosis. Regressive aspects similar to those of neoplastic cells were observed in prostatic intraepithelial neoplasia.


CONCLUSIONS
Our assessment of the biologic effects of NADT on tumoral activity of prostatic carcinoma led us to conclude that NADT can reduce the cellular proliferation of neoplastic cells.
Polito
M
M
Institute of Urology, University of Ancona Medical School, Italy.
Muzzonigro
G
G
Minardi
D
D
Montironi
R
R
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005485:Flutamide / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000726:Androgen Antagonists; D018809:Proliferating Cell Nuclear Antigen; D007987:Gonadotropin-Releasing Hormone; D005485:Flutamide