Can prostate epithelial content predict response to hormonal treatment of patients with benign prostatic hyperplasia?

Objectives. There are large interindividual differences in response to medi cal therapy for men with benign prostatic hyperplasia. Selection of patient s for alpha-blocker versus hormonal treatment is often based more on assump tions than on well-documented knowledge. A more scientifically based decisi on of therapy has a potential for economical savings and increased effectiv eness. Methods. We performed morphometry on prostate biopsy specimens and determin ed the amount of stroma, epithelium, and glandular lumen (pretreatment char acteristics) in 34 men with benign prostatic hyperplasia before 24 weeks of androgen suppressive therapy. Androgen suppressive therapy consisted of ei ther the luteinizing hormone-releasing hormone agonist leuprolide depot (3. 75 mg intramuscularly every 28 days) or the nonsteroidal antiandrogen bical utamide (50 mg/day orally). The evaluation of the clinical response (effect iveness parameters) was based on changes in prostate volume, peak urinary f low rate, symptom score, and bladder outlet obstruction. Results. A large prostate volume before treatment was associated with more pronounced symptom score improvement, but neither prostate-specific antigen nor any of the parameters of tissue composition used (percentage of epithe lium, epithelial volume, and stromal/epithelial ratio) predicted a favorabl e response to hormonal treatment. Conclusions. The pretreatment variables that are readily available at prese nt have a limited role in helping clinicians to decide the optimal medical treatment for patients with benign prostatic hyperplasia. UROLOGY 56: 261-2 66, 2000, (C) 2000, Elsevier Science Inc.