Nuclear deoxyribonucleic acid determination in patients with prostate carcinomas: clinical research and application

The objective of this prospective study of patients with prostate carcinoma was to assess the diagnostic and prognostic value of DNA measurements based on fine-needle aspirates of the prostate. Two hundred and eighty-seven untreated patients under active surveillance and 309 hormonally treated patients were followed for a minimum of 10 years. Five hundred and six patients with cytologic benign prostate lesions served as the control group. The subdivision of tumors into diploid, tetraploid and aneuploid enabled further characterization of cytologically defined tumors. By repeated biopsies of untreated patients an increasing dedifferentiation combined with a shift towards aneuploidy at an annual rate of about 16% was found, leading to tumor heterogeneity. Significantly better survival for untreated patients over hormonally treated patients was found when comparing patients of same stage, grade and tumor ploidy. The reason was the adverse effect of androgen deprivation on tetraploid and aneuploid tumors. This unexpected finding was considered due to the elimination of hormone-dependent diploid tumor parts, leading to growth advantage for hormone-independent tetraploid or aneuploid cell lines. Multivariate analysis confirmed the high prognostic value of tumor ploidy, particularly in low-grade, low-stage tumors in which other known variables did not provide any prognostic information.