Evaluation of Cellular Immunologic Responsiveness in the Clinical Management of Patients with Prostatic Cancer

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Abstract
The effect of estrogen, cryosurgery and transurethral resection (TUR) of the prostate on the blastogenic response of thymic-dependent peripheral blood lymphocytes (PBL) to the non-specific mitogen, phytohemagglutinin (PHA) was evaluated as 1 in vitro criterion of each of these treatment modalities on the cellular immunologic responsiveness of 24 patients with prostatic cancer. A depression 5 days following receipt of estrogen and 2-7 days following cryosurgery or TUR of the responsiveness of PHA-stimulated PBL was observed. Estrogen-induced aberrations of responsiveness may not only be of relevance in prostatic cancer patients, but also to the suggested association between uterine cancer and prolonged administration of diethylstilbesterol and the development of vaginal tumors in offspring found in association with maternal ingestion during pregnancy. Particularly striking was that contrary to the reduced responsiveness of PBL cultured in autologous and homologous serum from patients receiving TUR, patients receiving cryosurgery, while also showing reduction in autologous serum, showed increased responsiveness when cultured in homologous serum. Although transient, depression of lymphocyte responsiveness, particularly if involving tumor-cloned T [thymus-derived] cells, may provide reduced surveillance to potential metastatic tumor cells leading to an alteration of tumor-host homeostasis. The potential of reduced tumor surveillance at least in the case of TUR appears to be supported by observations that patients expiring from prostatic cancer had an antecedent TUR. The possibility of identifying those patients possessing aberrations of responsiveness prior to therapy and those prone to develop or undergo further reductions in their responsiveness following the presently evaluated treatment modalities would appear to be of real and relevant concern in the management of the patient with prostatic and other types of malignant neoplasms. The possibility of pre-operative and/or post-operative immunotherapy in such patients may be indicated pending further study.