[Treatment of prostatic carcinoma in clinical stage C. Comparison between radiotherapy plus hormonal therapy after progression and immediate hormonal therapy]. / Terapia del carcinoma prostatico allo stadio clinico C. Confronto tra radioterapia più ormonoterapia dopo progressione e ormonoterapia immediata.

The optimal treatment of prostate cancer in clinical stage C is controversial. On the one hand a disease still confined by definition, as stage C is, should require a curative therapy such as surgery or radiotheratherapy. On the other hand the known fact that 50% of stages C are pathological stages D1, should propose a palliative, even thou effective, medical treatment. In fact both choices are questionable. A radical treatment risks being insufficient, whereas a palliative does not allow for giving a chance of a theoretically possible cure. In an attempt to resolve this difficulty, a sort of compromise is proposed. The patients should be initially treated with radical radiotherapy, and only in the case of progression will standard hormonotherapy be given. Thanks to this behaviour a possibility of cure is maintained, and, in addition, when suffering a progression the patients are likely to benefit from hormonotherapy owing to the fact that they are not pretreated. From 1985 to 1991 forty-eight clinical stage C patients were observed. They were given the choice between two treatments after explaining the theoretical benefits and disadvantages of both. Treatment A consisted of cobalt-60 therapy followed by hormonotherapy after progression, treatment B in primary ormonotherapy with LH-RH analogue +/- Flutamide. Twenty patients opted for treatment A and 21 for B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical significance of the local response to prostatic carcinoma during hormonotherapy]. / Significato clinico della risposta locale nei carcinomi della prostata in corso di ormonoterapia.

The main goal of hormonotherapy in management of locally advanced or metastatic prostate cancer is the control over the progression of the neoplastic disease rather than a possible benefit to the primary lesion. Nevertheless during hormonal treatment an evident decrease of prostatic volume can often be noted even though its clinical meaning has rarely been investigated. In order to evaluate a possible correlation between local modifications and prognosis, a retrospective analysis of a group of patients on hormonotherapy was performed. From March 1987 to March 1991, 98 patients with clinical stage C and D2 prostate cancer were treated. Fifty two of them were considered eligible for assessing local response because they had had neither surgery nor radiotherapy over the prostate; moreover their pre-treatment prostatic volume, as assessed by US scan, exceeded 22 ml. Out of these patients 24 were given Goserelin every 4 weeks and the remaining 28 added Flutamide at the dose of 750 mg per day. The prostatic volume was assessed quarterly and considered as response if decreased more than 35% of pretreatment value or as progression if increased over 25% of immediately previous value. In both cases the result needed to be confirmed three months later, but it was registered when first observed. After a mean follow-up of 32.4 +/- 18.7 months a local response occurred in 44 patients (84.6%) during a period ranging 3 to 18 months. Eight patients did not show a prostatic volume decrease and 4 suffered of local progression. In these latter cases the local progression coincided with distant progression.(ABSTRACT TRUNCATED AT 250 WORDS)

[Advanced carcinoma of the prostate (stages C and D). Mortality within 12 months of the initiation of hormonal therapy]. / Carcinoma avanzato della prostata (stadi C e D). Mortalità entro 12 mesi dall'inizio della terapia ormonale.

Seventy-three patients with stage C and D prostatic carcinoma were treated with hormonotherapy. During a mean follow-up of 27 +/- 17.8 months, 30 tumour-related deaths were registered. The patients in the G3 subset suffered a 35.7% early death rate versus a 10.1% rate of G1-2 ones. This difference is significant (p = 0.0102). Nevertheless the Authors' opinion is that G3 patients should not be given a more aggressive treatment initially apart from the case of a controlled trial.

Recurrences during the chemoprophylactic treatment of superficial tumors of the bladder.

A total of 88 patients who underwent resection for superficial stages Ta and T1 bladder tumors received chemoprophylactic treatment to prevent recurrence postoperatively. The first 44 patients were given doxorubicin at monthly intervals and the second 44 received doxorubicin plus mitomycin C alternately, with the first 6 instillations at weekly intervals and the rest monthly beginning 1 month after resection. Recurrences during treatment were assessed as an index of drug resistance. Tumor developed while the patients were undergoing treatment (9 to 10 months) in 15.9 per cent (7 of 44) of group 1 patients, 18.1 per cent (8 of 44) of group 2 patients and 17.0 per cent (15 of 88) of the total patients studied. At the initial post-treatment cystoscopy 12 to 16 months later 2 more patients in group 1 and none in group 2 had recognizable tumors. Treatment was continued in patients with recurrences. A total of 41 recurrences in 435 months of followup was recorded, for a rate of 9.42 recurrences per 100 patient-months. No worsening of the histological grading was noted but 2 patients with initial stage T1 disease had subsequent carcinoma in situ.