From June 1, 1981 to December 31, 1985, 122 patients aged 54 to 83 years, with locally advanced prostatic
carcinoma, were treated with
buserelin. Nineteen of the patients received combined
therapy with
buserelin and
androcur for the first 3 months. To control the response of the primary
tumor to
therapy, fine-needle aspiration biopsy of the prostate was made in all patients at 3-month intervals. Fifty-eight (76.3%) of 76 patients with locally advanced prostatic
carcinoma, with or without bone
metastases, who underwent
buserelin therapy for periods of 12-54 months showed good to satisfactory regression grades in the primary
tumor. Eighteen patients (23.7%) showed poor regression or none, established by cytological findings and the measure of
DNA by means of single cell-scanning cytophotometry. In three of the 58 patients,
tumor progression or bone
metastases occurred despite favorable regression grade; these were the only cases in which there was a discrepancy between the
clinical course of the disease and the grade of regression in the primary
tumor. According to TNM classification, 68 of the 78 patients treated for 12-54 months were in stage T3 NX M0; eight were in stage T3/T4 NX M1. On the basis of our long-term studies, it can be stated that
buserelin therapy induces positive
therapy response in more than 75% of locally advanced, inoperable, primary prostatic
carcinoma. The clinical
castration caused by
buserelin through selective suppression of gonadotrophic secretion in the pituitary gland is, as the term implies, no more effective than surgical
castration. However, the gonadotrophin suppression induced by
buserelin is reversible and spares the patient the psychic stress of
orchiectomy. This is a decisive advantage in light of the fact that in 20-40% of patients with locally advanced primary prostatic
carcinoma, the primary
tumor is
hormone-refractory, and surgical
castration would prove unnecessary after all.