SUPERSENSITIVE PSA-MONITORED NEOADJUVANT HORMONE-TREATMENT OF CLINICALLY LOCALIZED PROSTATE-CANCER - EFFECTS ON POSITIVE MARGINS, TUMOR-DETECTION AND EPITHELIAL-CELLS IN BONE-MARROW

Objective: The present study was done to investigate the effects of su persensitive PSA-controlled inductive treatment on positive margins, d etection 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) th ird-generation assay) reached <0.1 ng/ml or the nadir value, as shown by two consecutive measurements at monthly intervals. Results: The res ultant 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 m argins was relatively high (35% from 55 patients) with cT3 tumors, but almost negligible (2% from 46 patients) in cT1-2 tumor. Our pathologi sts, despite their great experience in evaluating hormonally treated p rostates (>500 cases) and using immunohistochemical staining, were una ble to detect carcinoma in 15 (15%) specimens. Whereas only 2 (4%) of the 55 cT3 specimens were without detectable tumor, this incidence ris ed to 28% (13 of 46 prostates) in patients with cT1-2 tumors. Of the i nitial 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. Conclusion: Endocrine induction controlled by a su persensitive PSA assay and continued until reaching PSA nadir is highl y effective in clearing surgical margins and eliminating tumor cells f rom bone marrow. It seems to be clearly superior to the conventional 3 months of pretreatment at least in cT1-2 tumors in respect to surgica l margins and detectability of tumor in the resected prostate. A defin itive statement about the value of endocrine induction can only be giv en by prospective randomized studies, with optimal drugs, doses and tr eatment time. But the conventional 3 months of pretreatment are far fr om exploiting the possibilities of this therapeutic option.