ADJUNCTIVE VALUE OF CELL-PROLIFERATION BUT NOT OF APOPTOSIS TO INTERPRET PATHOLOGICAL EFFECTS ON PROSTATIC-CANCER AFTER NEOADJUVANT ENDOCRINE THERAPY

Background: The current histological evaluation of the effects of endo crine therapy has difficulty in distinguishing pathologic degeneration caused by androgen ablation from residual poorly differentiated tumor . Therefore, we examined the changes in cell proliferation and apoptos is before and after endocrine therapy and analyzed whether they correl ated with pathologic effects and histological differentiation. Methods : Between January 1986 and December 1995, 52 patients with clinical st age B2 and C prostate cancer underwent radical prostatectomy after neo adjuvant endocrine therapy (median duration 3.8 months). Proliferative and apoptotic activities of pretreatment biopsy specimens and radical prostatectomy specimens were analyzed with MIB-1 monoclonal antibody and in situ end-labeling of fragmented DNA. Results: The mean prolifer ative index (PI) of radical prostatectomy specimens was significantly lower than that of biopsy specimens (P = 0.000 003) and the decrease i n PI after endocrine therapy was significantly related to histological differentiation (P = 0.014). There was a weak relationship between th e decrease in PI after endocrine therapy and pathologic effects (P = 0 .054), while in pathologically effective cases (Grades 2 and 3), three out of 16 (19%) showed a <50% decrease in PI after endocrine therapy, and may be regarded as having poorly differentiated tumors, The mean apoptotic index (Al) of prostatectomy specimens tended to be higher th an that of biopsy specimens (P = 0.054). The increase in Al after endo crine therapy was not related to histological differentiation and path ologic effects. Conclusion: Pathologic effects caused by endocrine the rapy may be in part misled by routine histopathologic staining and the change in PI may help in recognizing the pathologic effects of endocr ine therapy and have adjunctive value for the interpretation of the ef fects of endocrine therapy.