Lock M, Loblaw D A, Choo R, Imrie K
Department of Radiation Oncology, University of Toronto, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada.
Can J Urol. 2001 Aug;8(4):1326-9.
PC-SPES is a herbal remedy gaining acceptance amongst prostate cancer patients and health care providers due to credible laboratory and clinical studies. However, PC-SPES has not been assessed in the standard rigorous approval process mandated for conventional agents.
To present a case of a patient with prostate cancer who, while using PC-SPES, developed disseminated intravascular coagulation (DIC). A review of the literature was conducted to determine if there is a relationship between PC-SPES and hemorrhagic disorders.
Searches were conducted in MEDLINE (1966-December 2000) and the Cochrane Collaboration's database.
There are 116 clinical and laboratory based studies of PC-SPES published to date. There are no randomized controlled trials. Clinical studies have demonstrated a significant reduction in prostate specific antigen (PSA) levels within 6 weeks. Improved quality-of-life, reduction in the volume of tumor deposits and reduction in analgesic use has been demonstrated in hormone refractory patients. Laboratory studies suggest that the beneficial effects of PC-SPES are unrelated to physiologic estrogens. However, PC-SPES has a side-effect profile similar to diethylstilbestrol. There is data demonstrating a <5% risk of thromboembolic events, but this is the first report of DIC.
The study of PC-SPES is in its infancy. This case may serve as a cautionary note to health care providers and patients regarding herbal remedies. Those using PC-SPES should have an increased level of surveillance for bleeding disorders.
PC-SPES是一种草药疗法，因其可靠的实验室和临床研究而在前列腺癌患者和医疗服务提供者中逐渐得到认可。然而，PC-SPES尚未经过传统药物所需的标准严格审批程序评估。
报告一例前列腺癌患者在使用PC-SPES时发生弥散性血管内凝血（DIC）的病例。对文献进行综述，以确定PC-SPES与出血性疾病之间是否存在关联。
在MEDLINE（1966年至2000年12月）和Cochrane协作网数据库中进行检索。
迄今为止，已发表了116项基于临床和实验室的PC-SPES研究。尚无随机对照试验。临床研究表明，6周内前列腺特异性抗原（PSA）水平显著降低。在激素难治性患者中，已证明生活质量得到改善、肿瘤沉积物体积减小以及镇痛药使用减少。实验室研究表明，PC-SPES的有益作用与生理性雌激素无关。然而，PC-SPES的副作用谱与己烯雌酚相似。有数据表明血栓栓塞事件的风险<5%，但这是DIC的首例报告。
PC-SPES的研究尚处于起步阶段。该病例可能为医疗服务提供者和患者就草药疗法敲响警钟。使用PC-SPES的患者应加强对出血性疾病的监测。
