Morphologic effects of neoadjuvant hormone therapy on prostate cancer

We have reported that neoadjuvant hormone therapy (NHT) combining the antia ndrogen flutamide and a luteinizing hormone-releasing hormone (LHRH) agonis t for 3 months leads to decreased tumor volume, capsular penetration, and m argin invasion in patients with localized prostate cancer, More recently, w e compared patients randomized to 3 and 6 months of NHT, The tumor volume w as further significantly decreased after 3 additional months of NHT, The hi stologic features and biologic characteristics of cancer tissue were also s trongly influenced by NHT, and cancer cells had features suggestive of low activity in prostates exposed to hormonal manipulation. Despite an apparent ly higher Gleason score and loss of androgen receptors, suggesting a select ion of more aggressive cell clones, nucleolar diameter and staining with th e cell proliferation marker Ki-67 were significantly reduced after 3 months of NHT compared with tumors from patients treated by surgery alone and wer e further reduced after 6 months of NHT, Although longer follow-up is neede d to assess whether those changes will translate into improved patient outc omes, our data clearly demonstrate that NHT in patients with prostate cance r leads to a marked downsizing of the tumor bulk and a marked decrease of c ancer cell activity.