Cytologic evaluation of aspired samples of palpable nodules in the human prostate developed into a routine method, since Esposti (5) classified carcinoma with high (Gl), moderate (G2), and poor (G3) differentiation and evaluated the prognostic importance.The malignant cells frequently have a different DNA content than do normal cells (1,3,7,8,13). The purpose of this study was to determine the DNA content of prostate cancer cells before and during endocrine therapy, to compare it with the cytologic grading, the clinical state, and to evaluate possible prognostic factors.
MATERIALS AND METHODSEighty patients with freshly diagnosed prostatic cancer underwent transrectal fine-needle aspiration biopsy prior to treatment (6). The biopsies were taken fanlike from the suspected area and neighboring unsuspected areas. Later repeat biopsies were taken from the same tumor region at 6-(n = 76) and 12-month intervals (n = 70) in surviving patients. The corresponding clinical state of complete or partial remission, stable disease, or progression was defined according to Schmidt et a1 (9).It was judged by digital rectal examination, percutaneous transvesical sonography, serum acid phosphatase activity, and radionuclide bone scan, followed by skeletal radiography in positive cases. Twenty patients with benign prostatic hypertrophy served as controls.The biopsied specimen was used for cytologic morphologic grading (5) and for single-cell fluorescence photometry (10-121, performed with the microscope photometer MPV 2 (Leitz, Wetzlar, West Germany).The samples were fixed with Merckofix spray and stored at +4-+8"C for the staining procedure. The samples were fixed again for 30 min in 96% ethyl alcohol and hydrolyzed in a thermostatic-controlled water bath at +28 f 0.2"C in 4N hydrochloric acid. Then 0.01% acriflavine-Schiff (Serva, Heidelberg, West Germany) was used for nuclear staining at room temperature for 1 hour. The samples were washed in SO2 solution, dehydrated in alcoholic solution, immersed in xylol for 5 min, and covered with nonfluorescent Cargille Oil (Cargille Laboratories, Cedar Grove, NY). This oil had a nucleuslike refractive index of nk0 = 1.54.About 100 cells were measured in every preparation. Normal prostate cells and leukocytes were used for evaluation of the normal diploid 2c DNA content. The values were displayed as histograms and analyzed statistically with the median-quartile test (2), because the DNA values differed in most cases from a normal distribution.Five parameters were extracted from the distribution of the DNA values and were used for the analysis. These parameters were the minimum, first quartile, median, third quartile, and maximum. A sixth parameter was Z, the 2c value, which was defined as the percentage of cells with a DNA content of 2c f 25% (12).
RESULTSThe pretherapeutic DNA histograms had single peaks, were bimodal, or showed a broadly scattered DNA disAddress reprint requests to Dr.