PROGNOSTIC VALUE OF DNA PLOIDY AND NUCLEAR MORPHOMETRY IN PROSTATE CANCER TREATED WITH ANDROGEN DEPRIVATION JOSE ´ M. MARTI ´ NEZ-JABALOYAS, JOSE ´ L. RUIZ-CERDA ´ , MIGUEL HERNA ´ NDEZ, ANA JIME ´ NEZ, AND FERNANDO JIME ´ NEZ-CRUZ ABSTRACT Objectives. To assess the prognostic value of flow cytometry and nuclear morphometry in prostate cancer after androgen deprivation treatment. Methods. A total of 127 patients with a prostate cancer diagnosis who had undergone androgen suppres- sion were retrospectively studied. The DNA content by flow cytometry and nuclear morphometry was studied from biopsy specimens. In the patients with Stage M0, two multivariate analyses by the Cox proportional regression model were performed to determine whether the experimental variables (DNA content and nuclear area) added independent information to the classic prognostic factors (Gleason score and stage). Using the statistical analysis results, risk groups were created. Results. T and M categories, Gleason score, DNA ploidy, and mean nuclear area proved to have prognostic value in the univariate analysis. For the group of patients free of metastasis (M0), it was possible to create low, intermediate, and high-risk groups using stage and Gleason score with statistically significant differ- ences in survival. Multivariate analysis, combining the classic and experimental variables, selected Gleason score and DNA content as prognostic independent factors. Also, risk groups with statistically significant differences in survival were created. However, the net result of combining both kinds of factors was at least as valuable as the combination of stage and Gleason score in predicting survival. Conclusions. The determination of DNA ploidy and mean nuclear area do not add enough independent information to improve the predictive value to justify their use in this group of patients treated with hormonal therapy. UROLOGY 59: 715–720, 2002. © 2002, Elsevier Science Inc. T he usefulness of DNA content determined by flow cytometry and nuclear morphometry to predict the behavior of a variety of neoplasias has been reported. 1,2 In prostate cancer, DNA ploidy adds clinically useful prognosis information after radical prostatectomy, antiandrogen therapy, and radiation therapy. 3,4 With regard to nuclear mor- phometry, although the first studies reported ap- peared very promising 5 in predicting prostate can- cer behavior, its usefulness has not been well defined owing to contradictory results. 6–9 The aim of our study was to evaluate the ability of DNA ploidy content and nuclear morphometry to predict mortality in patients with prostate cancer who had undergone androgen deprivation. MATERIAL AND METHODS PATIENT CHARACTERISTICS A total of 127 patients with prostate adenocarcinoma diag- nosed in our hospital from 1975 to 1988 were selected. All patients had received androgen deprivation, had more than 10 years of follow-up, and had undergone pretreatment staging. Stage information was obtained from digital rectal examina- tion, transrectal and abdominal ultrasonography, chest radi- ography, abdominopelvic computed tomography, and bone scanning. The TNM classification of 1997 10 was used. No dis- crimination was made between patients with Stage N0 and N1. PATHOLOGIC EXAMINATION Needle biopsy specimens were used to for the pathologic examination. Histologic sections from tumor tissue specimens of each case were taken from the pathology files and those with higher tumor content and less differentiation were selected. Paraffin-embedded blocks were chosen, and five sections were performed on each block: one of 5 m, 3 of 50 m, and finally From the Departments of Urology and Pathology, Hospital Uni- versitario La Fe, Valencia, Spain Reprint requests: Jose ´ M. Martı´nez-Jabaloyas, M.D., Depart- ment of Urology, Hospital Clı ´nico Universitario, Avda de Blasco Iba ´n ˜ ez, 17, Valencia 46010, Spain Submitted: July 24, 2001, accepted (with revisions): January 2, 2002 ADULT UROLOGY © 2002, ELSEVIER SCIENCE INC. 0090-4295/02/$22.00 ALL RIGHTS RESERVED PII S0090-4295(02)01530-3 715