Estimation of total PSA with a supersensitive PSA-assay during neo-adjuvant-chemotherapy of prostate cancer before radical resection of prostate.
43 patients with untreated and clinically localised prostate carcinoma (cT1-3NoM0) were submitted to neo-adjuvant complete androgen deprivation treatment and radical prostatectomy. Hormonal treatment was given until PSA (supersensitive Immulite 3rd generation assay) reached a value of < 0.1 ng/ml or the nadir value. The resultant mean duration of treatment was 6 months (3-22 months). 93% of our patients reached a PSA value of 0.1 ng/ml or below. The nadir of 6 patients was between 0.1-0.3 ng/ml. In one case it remained above 0.3 ng/ml. 82% had a measurable hypoechoic lesion on initial transrectal ultrasound. 84% of these became smaller, 7.5% remained unchanged and 8.5% increased. Of the patients with cT1-2 tumours 2% had a positive margin and in 28% of the specimens no tumour tissue could be detected at the time of prostatectomy. Of the initial patients with epithelial cells in bone marrow only 14% remained positive after controlled induction and all of them had fewer cells than before. Five patients relapsed showing raising PSA values > 0.1 ng/ml in the follow-up. In this group the mean PSA and the time of nadir was significantly higher (0.15 ng/ml) than the mean PSA at the time of nadir of the rest of the group (0.06 ng/ml). Supersensitive PSA assays like Immulite 3rd generation offer a valuable tool to collect data for clinical evaluation to optimise therapy of prostate carcinomas.
Spitz
J
J
Clinic for Urology, Academic Hospital (HSK), Germany.
Enzmann
T
T
Müller
W
W
Weidenfeld
M
M
Köllermann
M
M
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005485:Flutamide / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D005485:Flutamide; D017430:Prostate-Specific Antigen; D016729:Leuprolide