Gonadotropin-releasing hormone (GnRH) analogues administered for the treatment of advanced prostatic cancer induce a transient increase in plasma testosterone levels during the first week of treatment, often with a secondary rise in plasma levels of prostatic acid phosphatase and a flareup of disease. To determine whether the antiandrogen nilutamide (Anandron) blocks these effects, we carried out a multicenter, placebo-controlled study of nilutamide in men with prostatic cancer treated with the GnRH analogue buserelin. Thirty-six men with disseminated prostatic cancer and elevated plasma levels of prostatic acid phosphatase were randomly assigned to two groups. Group 1 included 17 men who received buserelin (500 micrograms daily subcutaneously) and nilutamide (300 mg daily by mouth); group 2 included 19 men treated with buserelin and placebo. Symptoms were assessed, and plasma was collected before treatment, daily for 14 days, and on days 18, 22, and 29 after the initiation of treatment. Bone pain appeared or worsened in 5 of the 17 men in group 1 and in 12 of the 19 men in group 2 (P less than 0.05). Acute urinary obstruction occurred in one man in group 2. Despite similar changes in the plasma testosterone levels in both groups, the median concentration of plasma prostatic acid phosphatase decreased almost immediately in group 1, but increased transiently, then decreased on day 14 in group 2. Median levels of prostate-specific antigen decreased immediately in group 1 and decreased on day 8 in group 2. We conclude that nilutamide can prevent the adverse consequences of the buserelin-induced transient rise in plasma testosterone levels in men with advanced prostate cancer treated with a GnRH analogue.

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Objective To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)‐guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. Patients and methods Of 158 patients submitted to RP for T1–T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extracapsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with post‐operative biological progression (P+), having a prostate‐specific antigen (PSA) level>0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. Results The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with <10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow‐up of 22 months. Conclusion A single positive needle‐biopsy in six systematic TRUS‐guided prostate biopsies is not predictive of low‐volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.

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