Furuya Y, Akakura K, Akimoto S, Inomiya H, Ito H
Department of Urology, School of Medicine, Chiba University, Japan.
Int J Urol. 1999 May;6(5):240-4. doi: 10.1046/j.1442-2042.1999.00060.x.
Patients with prostate cancer generally respond to androgen ablation therapy, but progression to androgen-independence is frequently observed. To further evaluate disease progression, the pattern of progression and survival in hormonally treated metastatic prostate cancer was examined.
One hundred and ninety-three patients with untreated metastatic prostate cancer (TxNxM ) who received endocrine therapy between 1986 and 1995 were included in the present study. The pattern of progression was evaluated in these patients.
One hundred and eighteen of the 193 patients (61.1%) had disease progression: 33 had local progression, 73 had distant progression and 12 had distant with local progression. Patients with only local progression had a longer interval to disease progression and longer survival than those with distant progression. The interval from disease progression to death in patients with local progression was longer than in those with distant progression. The patients whose prostate-specific antigen (PSA) had not been normalized 3 months after the start of endocrine therapy had a tendency to progression either into the prostate or into distant sites. Patients with extent of disease (EOD) scores of 3 and 4 progress, especially to distant sites, after endocrine treatment.
In untreated metastatic prostate cancer, patients with a poor response of PSA levels and patients with a high volume of bone metastasis (i.e. EOD 3, 4) were in the high-risk group for progression, especially to distant sites. Progression into distant sites was a poor prognostic factor for patients with recurrence to endocrine therapy.
前列腺癌患者通常对雄激素剥夺疗法有反应，但雄激素非依赖性进展却屡见不鲜。为进一步评估疾病进展情况，对接受激素治疗的转移性前列腺癌的进展模式和生存情况进行了研究。
本研究纳入了1986年至1995年间接受内分泌治疗的193例未经治疗的转移性前列腺癌（TxNxM）患者。对这些患者的进展模式进行了评估。
193例患者中有118例（61.1%）出现疾病进展：33例为局部进展，73例为远处进展，12例为远处合并局部进展。仅局部进展的患者与远处进展的患者相比，疾病进展间隔时间更长，生存期也更长。局部进展患者从疾病进展到死亡的间隔时间比远处进展患者更长。内分泌治疗开始3个月后前列腺特异性抗原（PSA）未恢复正常的患者有向前列腺或远处部位进展的倾向。疾病范围（EOD）评分为3分和4分的患者在内分泌治疗后会进展，尤其是向远处部位进展。
在未经治疗的转移性前列腺癌中，PSA水平反应不佳的患者和骨转移量大（即EOD 3、4）的患者是进展的高危人群，尤其是向远处部位进展。远处部位进展是内分泌治疗复发患者的不良预后因素。
