RESUMO
This article reviews the history of hormonal therapy for prostate cancer, beginning with the studies of Huggins and Hodges completed in the 1940s. Although early clinical reports suggested that major improvements and even cure could be obtained, later randomized investigations showed that hormonal treatments were palliative rather than curative. Later investigators demonstrated that prostate cancer is under the trophic influence of male hormones and that ablation of androgens could cause cancer regression. More recently, neoadjuvant and adjuvant hormonal therapy has been shown to improve outcomes for higher-risk patients who receive radiation as definitive local therapy. Numerous studies have attempted to devise hormonal therapy regimens that decrease the adverse physiologic consequences of the currently existing agents and to define the patient population and stage of prostate cancer that most benefit from the use of hormonal therapy, either alone or in association with additional agents. New hormonal agents currently in clinical trials may increase the options available for patients who have metastatic cancer or are at increased risk of recurrence after surgery or radiation.
RESUMO
Prior meetings of the International Conference on Neoadjuvant Hormonal Therapy in Prostate Cancer identified areas of concern in the pathologic analysis of post-treatment specimens. In response, a pathology subcommittee was formed to address the questions that had been raised. Recommendations are made here concerning pretreatment biopsy review and reporting, handling and reporting of radical prostatectomy specimens, Gleason scoring of treated cancer, grading of therapy effect, role of immunohistochemistry procedures, and the significance of high-grade prostatic intraepithelial neoplasia. Neoadjuvant trials with both surgery and radiation therapy were considered in drawing up these recommendations.
