title: [Histopathological effect and its predictors of neoadjuvant hormonal therapy by combined androgen blockade].
abstract: OBJECTIVE
  Combined androgen blockade (CAB) uning LH-RH agonist and flutamide has been performed as neoadjuvant therapy for T 2, 3 prostate cancers (CaP). The histological effects of neoadjuvant CAB therapy and influential factors were investigated.
  
  
  METHODS
  Materials were 20 CaP cases which were underwent radical prostatectomy (RP) after neoadjuvant CAB therapy. All cases were diagnosed by echo-guided sextant needle biopsies. RP was performed after serum PSA was decreased to undetectable level. Histological effect was evaluated by general rule for clinical and pathological studies on prostate cancer (Japanese Urological Association). All cases were divided 2 groups by histological effects as follows: Group A (poor effect group): G 0 and G 1, Group B (good effect group): G 2 and G 3. Immunostaining of p 53 (mutant type), bcl-2 and Chromogranin A (ChA) were performed for both pretreatment needle biopsy and RP specimen. In addition, pretreatment serum PSA and Gleason grade were also investigated.
  
  
  RESULTS
  Down grading were found in 30%. Down staging were found in 35% (7 cases). All 7 cases were negative surgical margins and 5 of 7 were clinical T 3. Negative bcl-2 of biopsy specimen was correlation with down grading (p = 0.008). In the histopathological evaluation, G 0 was 1, G 1 were 10, G 2 were 6 and G 3 were 3 cases. Gleason 4 or 5 elements of biopsy were found in 9/11 cases in Group A but only 3/9 cases in Group B (p = 0.027). The bcl-2 positive cells of biopsy were found in 8/11 cases in Group A but only 1/9 cases in Group B (p = 0.006). The p 53 and/or bcl-2 positive cells of biopsy were found in 10/11 cases in Group A but only 3/9 cases in Group B (p = 0.007). Serum PSA and ChA were not correlation with histological effect of neoadjuvant CAB therapy. But, in 3 cases, ChA positive cell appeared after neoadjuvant therapy.
  
  
  CONCLUSIONS
  We could not expect more than 50% cases to show the down grading and down staging. But, in T 3 case, surgical failure could be decrease. We could expect prostate cancer cases without positive bcl-2 cells, p 53 over expression and Gleason 4 x 5 to reveal the good histological effects of neoadjuvant CAB therapy.
authors.affiliation: Department of Urology, Tokyo Medical University.
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.forename: Y
authors.initials: Y
authors.lastname: Mamiya
authors.forename: T
authors.initials: T
authors.lastname: Aizawa
authors.forename: A
authors.initials: A
authors.lastname: Akiyama
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.forename: M
authors.initials: M
authors.lastname: Tsuzuki
authors.forename: O
authors.initials: O
authors.lastname: Yoshimasa
authors.forename: M
authors.initials: M
authors.lastname: Miki
authors.forename: M
authors.initials: M
authors.lastname: Furusato
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000726:Androgen Antagonists