The Prognostic Value of Modal Deoxyribonucleic Acid in Low Grade, Low Stage Untreated Prostate Cancer

Abstract

We selected for a prospective surveillance study 167 patients with untreated grades 1 and 2 prostate cancer. The tumors were classified regarding modal deoxyribonucleic acid value (ploidy) by flow cytometry, cytological grade by transrectal fine needle aspiration biopsy and local tumor stage. Of the patients 146 could be evaluated. Mean followup was 50 months. The initial ploidy was statistically correlated to cytological grade but not to initial local tumor stage, prostatic acid phosphatase activity or patient age. Initial ploidy and cytological grade had a prognostic value regarding local tumor progression when considered as single predictors and in combination. Two patients with diploid and 8 with nondiploid tumors initially had metastases during the surveillance. Five patients (1 with diploid and 4 with nondiploid disease) died of prostatic cancer. Modal deoxyribonucleic acid value and cytological grade were of prognostic value in untreated prostate cancer.

Prognostic and treatment-predictive factors—is there a difference?

“…7 However, patients with diploid prostate cancers with regional lymph node metastases managed by radical prostatectomy fared better than similar patients with tetraploid and aneuploid tumors. 8 If these two observations re¯ect the true situation, ploidy is not prognostic for patients with localized tumors but predictive for the treatment effect when patients with N /D1 prostate cancer are managed by radical prostatectomy (Figure 3).…”

Flow cytometric analysis of DNA ploidy and S-phase fraction from prostatic carcinomas: implications for prognosis and response to endocrine therapy

“…However, it is still controversial whether aneuploidy is an independent prognostic indicator. At least four groups have reported DNA aneuploidy to be an additional prognostic factor in prostate cancer (Adolfsson et al, 1990; Montgomery et al, 1990;Nativ et al, 1989;Stephenson et al, 1987), whereas some other investigators have failed to detect any independent value for aneuploidy after correcting for the effect of other prognostic indicators (Detjer et al, 1989;Haugen & Mjolner6d, 1990;Ritchie et al, 1988).…”

New Prognostic Factors in Prostatic Carcinoma

“…Only two flow-cytometric studies failed to find any prognostic value for DNA aneuploidy [45,75], Furthermore, in one of these studies [75], aneu ploidy was defined not only as the presence of a distinct aneuploid peak but also as the presence of more than 15% hyperdiploid cells. Four flow-cytometric studies indicate that DNA ploidy provides independent information on prognosis [37,47,49,54], In four other studies this inde pendent prognostic value could not be verified [44,52,58,61]. Also one of the image-cytometric studies showed an independent prognostic significance for DNA aneu ploidy in prostatic carcinoma [74], In our own studies [61,76] DNA aneuploidy was found to be associated with poor prognosis.…”

“…Counting the number of mitoses per high-power field was the first method available. How ever, it suffers from poor accuracy and reproducibility, Frankfurt et al [33] Fordham et al [34] DiSilverio and Sciarra [35] Lundberg et al [36] Stephenson et al [37] Lee et al [38] Currin et al [39] Winkler et al [40] Willumsen et al [41] Mclntire et al [42] Klein et al [43] Ritchie et al [44] Detjer et al [45] Neill et al [46] Nativ et al [47] Biute et al [48] Montgomery et al [49] Nativ et al [50] Stege et al [51] Haugen and Mjölneröd [52] Jones et al [53] Adolfsson et al [54] Adolfsson and Tribukait [55] Robertson and Paulson [56] Nordgren et al [57] Humphrey et al [58] Badalament et al [59] Tribukait [60] Visakorpi [61] Eskelinen et al [62] Miller et al [ Patient total = 3,427, mean DNA aneuploidy = 50%. p ethanol-fixed sample; A = prostatic-carcinoma-specific survival; B = progression-free survival; C = overall survival.…”