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Management of localized prostate cancer
1Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765.
Background:
Given the variable natural history of prostate cancer, prognostic parameters are needed to help guide treatment decisions in individual patients. In some series, analysis of DNA ploidy has correlated well with prognosis. This review was performed to determine whether flow cytometry could be used to help guide treatment decisions in patients with localized carcinoma of the prostate.
Methods:
Two hundred consecutive patients were observed for a minimum of 10 years after radical prostatectomy. Follow-up information was incomplete in 14 patients, leaving 186 for analysis. Clinically, there were 72% Stage B tumors and 28% Stage A.
Results:
Sixty percent of patients were alive with a minimum of 10 years of follow-up, and 47% apparently were tumor free. Twenty-two percent died of carcinoma of the prostate and 18% of other causes. The median time until death from prostate cancer was 6.5 years. Seventy-four percent of tumors were diploid on flow cytometry. Fifty-three percent of patients with diploid tumors survived 10 years without recurrence, whereas 20% died of carcinoma of the prostate. Aneuploid tumors were identified in 16% of the total group; 47% of these patients were alive at 10 years, whereas 24% had died of prostate cancer.
Conclusions:
Aneuploid tumors have a worse overall prognosis than diploid lesions. However, the correlation is not strong enough to allow treatment decisions on an individual patient basis. Analysis of DNA ploidy was no more accurate than Gleason histologic grading.