Sciarra A, Di Chiro C, Voria G, Colella D, Loreto A, Pastore A L, Di Silverio F
Department of Urology U. Bracci, University La Sapienza, Viale Policlinico, 00161 Rome.
Minerva Urol Nefrol. 2000 Mar;52(1):1-6.
To analyze the modifications in serum PSA levels during IAD in patients with an initial PSA progression after radical retropubic prostatectomy (RRP).
Between February 1994 and May 1996, 34 consecutive patients with an initial PSA progression (> 0.4 ng/ml) after RRP were selected. All men had localized adenocarcinoma of the prostate, stage pT2 pN0 M0. Patients were offered IAD when PSA progressed over 0.4 ng/ml. The initial treatment period with complete androgen deprivation (CAD) lasted 24 weeks in all cases. After, an acceptable nadir PSA level was considered to be a value < or = 0.4 ng/ml. CAD was then with held until serum PSA increased to a value over 0.4 ng/ml.
Follow-up ranges from 144 to 228 weeks. The median time for the first 5 treatment cycles was 32, 24, 28, 32 and 32 weeks respectively, with a median time "off" therapy that increased from 8 weeks (first cycle) to 22 weeks (fifth cycle). The median nadir PSA value during "on" treatment period was 0.20 ng/ml in all 5 cycles. So far, in none of the patients did a serum PSA fail to decrease during "on" treatment period.
We suggest that IAD may be an effective therapy in patients with an initial PSA progression after RRP. However, large prospective studies are needed to confirm these results and to better understand the meaning of PSA variations.
分析耻骨后根治性前列腺切除术（RRP）后初始前列腺特异抗原（PSA）进展的患者在间歇性雄激素剥夺（IAD）治疗期间血清PSA水平的变化。
在1994年2月至1996年5月期间，连续选择34例RRP后初始PSA进展（>0.4 ng/ml）的患者。所有男性均为局限性前列腺腺癌，pT2 pN0 M0期。当PSA进展超过0.4 ng/ml时，为患者提供IAD治疗。所有病例中，完全雄激素剥夺（CAD）的初始治疗期持续24周。之后，可接受的PSA最低点水平被认为是≤0.4 ng/ml。然后停止CAD治疗，直到血清PSA升高至超过0.4 ng/ml。
随访时间为144至228周。前5个治疗周期的中位时间分别为32、24、28、32和32周，中位“停药”时间从第1周期的8周增加到第5周期的22周。在所有5个周期的“治疗中”期间，PSA最低点的中位值为0.20 ng/ml。到目前为止，在“治疗中”期间，没有患者的血清PSA未能降低。
我们认为IAD可能是RRP后初始PSA进展患者的一种有效治疗方法。然而，需要大型前瞻性研究来证实这些结果，并更好地理解PSA变化的意义。
