Caldiroli M, Cova V, Lovisolo J A, Reali L, Bono A V
Urology Division, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Eur Urol. 2001 Jan;39 Suppl 2:6-10. doi: 10.1159/000052550.
Locally advanced and metastatic prostate cancer eventually progresses in spite of complete androgen blockade. Second-line therapy is usually disappointing, and further progression is the rule. Laboratory and clinical data have indicated that antiandrogen withdrawal may be a valuable strategy in the treatment of these patients. However, after antiandrogen withdrawal, controversial clinical results have been reported. Therefore every contribution to this therapeutic strategy is useful.
Herein we present our experience with antiandrogen discontinuation in a series of 44 patients with locally advanced or metastatic prostate cancer treated with complete androgen blockade (CAB).
Prostate-specific antigen (PSA) decline was observed in 13 of 44 (29%) and in 11 of these patients the reduction was greater than 50%. No response or further progression after antiandrogen withdrawal was observed in 31 of the 44 patients (71%). Among these patients 14 died due to prostate cancer after a mean period of 5.6 months. No patient in the responding group has died.
Our data indicate that approximately 30% of patients with advanced prostate cancer treated with CAB respond to antiandrogen withdrawal with a reduction in serum PSA levels. Even though it is not clear whether this PSA reduction produces a benefit in terms of survival, we feel that antiandrogen withdrawal must be the first therapeutic maneuver in patients with advanced prostate cancer who progress after CAB. If there is no PSA response within 4 months, second-line treatment is necessary.
尽管实施了完全雄激素阻断治疗，但局部晚期和转移性前列腺癌最终仍会进展。二线治疗通常效果不佳，疾病进一步进展是常见现象。实验室和临床数据表明，抗雄激素撤药可能是治疗这些患者的一种有价值的策略。然而，抗雄激素撤药后，已报道了存在争议的临床结果。因此，对这一治疗策略的每一项贡献都是有用的。
在此，我们介绍了对44例接受完全雄激素阻断（CAB）治疗的局部晚期或转移性前列腺癌患者进行抗雄激素撤药的经验。
44例患者中有13例（29%）观察到前列腺特异性抗原（PSA）下降，其中11例患者的PSA下降超过50%。44例患者中有31例（71%）在抗雄激素撤药后无反应或疾病进一步进展。在这些患者中，14例在平均5.6个月后死于前列腺癌。反应组中无患者死亡。
我们的数据表明，接受CAB治疗的晚期前列腺癌患者中，约30%对抗雄激素撤药有反应，血清PSA水平降低。尽管尚不清楚这种PSA降低是否能带来生存获益，但我们认为，抗雄激素撤药必须是CAB治疗后疾病进展的晚期前列腺癌患者的首要治疗手段。如果4个月内PSA无反应，则需要进行二线治疗。
