Cytologic regression grading of hormone-treated prostatic cancer

Aspiration cytology during hormone treatment of prostatic cancer has been regularly performed at the University of Munich for 13 years and gives direct information on the primary tumor. To analyse its value in clinical practice, 919 biopsies of 187 patients were reviewed without knowledge of clinical data and the charts were analysed retrospectively. Each biopsy was classified as having good, medium, or poor therapeutic response depending on the regressive changes of the cells. Agreement between two independent observers was 89%. All but 39 of these patients have died and the surviving patients have a minimum observation period of 5.6 years. A poor therapeutic response was seen cytologically in 72 patients (38.5%) at variable times after treatment began. These patients have a statistically significant worse survival in comparison to all other patients. Forty-seven of these 72 patients had deterioration, but clinical signs developed later in 23 cases (mean 1.1 years); in 21 patients cytology and clinical signs were simultaneous and in only three cases clinical deterioration preceded aspiration cytology (mean 4.8 months). In 25 cases there was a cytologically poor therapeutic response, but no clinical signs of deterioration. These patients had the same survival rate as with good or medium treatment response. Serial aspiration cytology is a very valuable parameter in treatment monitoring and is often the early warning sign of endocrine treatment failure.