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[The effect of combined endocrine therapy on prostate and testis]
1Institute of Urology, First Hospital, Beijing Medical University, Beijing 100034.
Objective:
To study the pathological changes of the effect of combined endocrine therapy on normal prostate, benign prostatic hyperplasia, prostatic adenocarcinoma and testis.
Methods:
11 radical prostatectomy specimens, 3 core-needle biopsies of prostate and 3 testes obtained after at least 3 months of enatone-flutamide inhibition therapy were studied. Step-section was performed on radical specimens and average 16 sections per case were reviewed. PSA, PSAP and AE1/AE3 were immunostained on 14 cases of prostate cancer and a comparative study pre- and post-treatment was made.
Results:
No residual tumor was recognized in 2 cases. Such characteristic changes were found in 9 cases as prominent acinar atrophy, decreased ratio of acini to stroma, stromal fibrosis, squamous metaplasia of carcinoma, cytoplasmic vaculation, nuclear shrinkage, and nucleolar shrinkage. No apparent change was discovered in 3 cases. Secretory epithelial atrophy and basal cell hyperplasia were the popular change in BPH and normal prostate. The expressions of both PSA and PSAP were markedly reduced in prostate carcinoma and nonneoplastic glands. Pathological downstaging of the tumor was not found statistically. Epithelial atrophy also existed in seminal vesicles and Leydig cells of the testes after hormone therapy.
Conclusions:
Combined endocrine therapy results in histologically distinctive changes that can be found in both nonneoplastic and neoplastic prostate tissue. However, the drugs can not eradicate prostate cancer completely. Testis atrophy is the direct action of the therapy.
Insights
Combined endocrine therapy causes distinct prostate tissue changes, including atrophy and reduced PSA/PSAP expression, but does not eradicate cancer. Testicular atrophy is a direct effect.
Area of Science:
- Oncology
- Endocrinology
- Pathology
Context:
- Combined endocrine therapy is a standard treatment for advanced prostate cancer.
- Understanding treatment-induced pathological changes is crucial for assessing efficacy and managing side effects.
Purpose:
- To investigate the histopathological alterations in normal prostate, benign prostatic hyperplasia (BPH), prostate adenocarcinoma, and testes following combined enzalutamide-flutamide therapy.
Summary:
- Histological examination of prostatectomy specimens and biopsies revealed significant changes including acinar atrophy, stromal fibrosis, and squamous metaplasia in neoplastic and non-neoplastic prostate tissues.
- Prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) expression were markedly reduced post-treatment.
- Testicular atrophy and Leydig cell changes were observed, alongside epithelial atrophy in seminal vesicles.
Impact:
- Combined endocrine therapy induces characteristic histological changes in prostate tissue, indicating treatment response.
- The therapy does not achieve complete tumor eradication in all cases.
- Testicular atrophy is a direct consequence of this hormonal intervention, highlighting potential side effects.