Homma Y, Akaza H, Okada K, Yokoyama M, Moriyama N, Usami M, Hirao Y, Tsushima T, Sakamoto A, Ohashi Y, Aso Y
Department of Urology, University of Tokyo, Japan.
Int J Urol. 1999 May;6(5):229-37; discussion 238-9. doi: 10.1046/j.1442-2042.1999.00050.x.
The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer.
Stage A2, B or C prostate cancers were randomized to one of two groups: (i) group I (n=90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) group II (n=86), who underwent the surgery followed by 3 month androgen deprivation and subsequent adjuvant endocrine therapy. The effects of preoperative androgen deprivation on clinical relapse (serum prostate specific antigen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA relapse (PSA >0.2ng/mL) were evaluated at 2 years after randomization.
There was no significant difference in clinical or PSA relapse-free survival and quality of life measures between the two groups, although relapses occurred significantly more frequently in patients who had more advanced stages, higher pretreatment PSA values or lower histologic differentiation in either group. Subgroup analysis indicated that clinical relapse-free survival in stage C cancer tended to be better in patients with preoperative androgen deprivation than in those patients without it (P< 0.1).
Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant endocrine therapy over the 2 year observation period. A longer follow up is needed to clarify the exact extent of benefit in terms of survival and quality of life.
在接受前列腺癌根治术及后续辅助内分泌治疗的患者中探讨术前雄激素剥夺的效果。
将A2期、B期或C期前列腺癌患者随机分为两组：（i）第一组（n = 90），术前接受3个月的雄激素剥夺治疗（亮丙瑞林和醋酸氯地孕酮），随后进行前列腺癌根治术及辅助内分泌治疗（仅用亮丙瑞林）；（ii）第二组（n = 86），先进行手术，然后接受3个月的雄激素剥夺治疗及后续辅助内分泌治疗。在随机分组后2年时评估术前雄激素剥夺对临床复发（血清前列腺特异性抗原（PSA）> 1.98 ng/mL、局部复发或远处转移）和PSA复发（PSA > 0.2 ng/mL）的影响。
两组之间在临床或PSA无复发生存率及生活质量指标方面无显著差异，尽管在任何一组中，疾病分期越晚、术前PSA值越高或组织学分化越低的患者复发频率明显更高。亚组分析表明，术前接受雄激素剥夺治疗的C期癌症患者的临床无复发生存率往往优于未接受该治疗的患者（P < 0.1）。
在2年的观察期内，术前雄激素剥夺可能对接受前列腺癌根治术及辅助内分泌治疗的C期前列腺癌患者有益。需要更长时间的随访以明确在生存和生活质量方面的确切获益程度。
