title: Supersensitive PSA-monitored neoadjuvant hormone treatment of clinically localized prostate cancer: effects on positive margins, tumor detection and epithelial cells in bone marrow.
abstract: OBJECTIVE
  The present study was done to investigate the effects of supersensitive PSA-controlled inductive treatment on positive margins, detection of tumor and epithelial cells in bone marrow of 101 patients with untreated and clinically localized prostatic carcinoma (cT1-3N0M0).
  
  
  METHODS
  Hormonal treatment was given until PSA (DPD Immulite(R) third-generation assay) reached <0.1 ng/ml or the nadir value, as shown by two consecutive measurements at monthly intervals.
  
  
  RESULTS
  The resultant median duration of treatment was 6 months (range 3-22). Ninety-three (93%) of our patients reached a PSA value <0.1 ng/ml. The nadir of 6 patients (6%) was between 0.1 and 0.3 ng/ml, and it remained >0.3 ng/ml in only 1 case. Of the 101 patients, 82 had a measurable hypoic lesion on initial transrectal ultrasound. 84% of these became smaller, 7.5% remained unchanged and 8.5% increased. Of the 101 prostatectomy specimens, 20 (20%) were margin-positive. The incidence of affected margins was relatively high (35% from 55 patients) with cT3 tumors, but almost negligible (2% from 46 patients) in cT1-2 tumor. Our pathologists, despite their great experience in evaluating hormonally treated prostates (>500 cases) and using immunohistochemical staining, were unable to detect carcinoma in 15 (15%) specimens. Whereas only 2 (4%) of the 55 cT3 specimens were without detectable tumor, this incidence rised to 28% (13 of 46 prostates) in patients with cT1-2 tumors. Of the initial 29 patients with epithelial cells in bone marrow, only 4 (14%) remained positive after controlled induction and all of them had fewer cells than before.
  
  
  CONCLUSIONS
  Endocrine induction controlled by a supersensitive PSA assay and continued until reaching PSA nadir is highly effective in clearing surgical margins and eliminating tumor cells from bone marrow. It seems to be clearly superior to the conventional 3 months of pretreatment at least in cT1-2 tumors in respect to surgical margins and detectability of tumor in the resected prostate. A definitive statement about the value of endocrine induction can only be given by prospective randomized studies, with optimal drugs, doses and treatment time. But the conventional 3 months of pretreatment are far from exploiting the possibilities of this therapeutic option.
authors.affiliation: Department of Urology, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Köllermann
authors.forename: K
authors.initials: K
authors.lastname: Pantel
authors.forename: T
authors.initials: T
authors.lastname: Enzmann
authors.forename: U
authors.initials: U
authors.lastname: Feek
authors.forename: J
authors.initials: J
authors.lastname: Köllermann
authors.forename: M
authors.initials: M
authors.lastname: Kossiwakis
authors.forename: U
authors.initials: U
authors.lastname: Kaulfuss
authors.forename: W
authors.initials: W
authors.lastname: Martell
authors.forename: J
authors.initials: J
authors.lastname: Spitz
mesh_terms: D000726:Androgen Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D001854:Bone Marrow Cells / Q000187:drug effects* / Q000473:pathology; D004847:Epithelial Cells / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011467:Prostate / Q000187:drug effects* / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen