Sharifi Nima, Dahut William L, Steinberg Seth M, Figg William D, Tarassoff Christopher, Arlen Philip, Gulley James L
Center for Cancer Research, National Cancer Institute/NIH, 10 Center Drive, Bethesda, MD 20892, USA.
BJU Int. 2005 Nov;96(7):985-9. doi: 10.1111/j.1464-410X.2005.05798.x.
To determine the natural history of patients with prostate cancer who start initial androgen-deprivation therapy (ADT) for biochemical failure with no radiographic evidence of disease (D0) or with radiographic metastatic disease (D2), as the history is either not well-defined or is changing, and such data are critical for guiding therapy after prostate cancer recurrence.
We retrospectively assessed the time to androgen-independence (AI), defined as the first sustained rise in prostate-specific antigen (PSA) level on ADT, time to metastatic disease and overall survival for 80 patients with metastatic prostate cancer in clinical trials at the National Cancer Institute.
ADT was initiated after metastatic disease in 37 patients and before metastatic disease in 43 patients; in these 43 patients, the median time to developing metastatic disease on ADT was 37.8 months. The median time to AI from the initiation of ADT was 19.3 and 13.1 months in D0 and D2 patients, respectively. The median overall survival from the start of ADT was 89.0 and 63.0 months, and the median overall survival from the time of AI was 63.1 and 44.2 months in D0 and D2 patients, respectively. These 80 patients, which included 43 who had no metastatic disease when starting ADT, had a median survival of 54.8 months after AI prostate cancer.
We describe the natural history of AI prostate cancer in D0 patients who eventually developed metastasis, and in D2 patients. The results suggest a longer than expected survival with AI prostate cancer, and to our knowledge this is the first study to report the time to metastatic disease for D0 patients from ADT and from AI. These results can be used to help design clinical trials in patients with D0 prostate cancer.
确定因生化复发而开始初始雄激素剥夺治疗（ADT）且无疾病影像学证据（D0）或有影像学转移疾病（D2）的前列腺癌患者的自然病史，因为目前对此类患者的病史定义尚不明确或正在发生变化，而这些数据对于指导前列腺癌复发后的治疗至关重要。
我们回顾性评估了美国国立癌症研究所临床试验中80例转移性前列腺癌患者达到雄激素非依赖（AI）的时间（定义为ADT期间前列腺特异性抗原（PSA）水平首次持续升高）、发生转移疾病的时间以及总生存期。
37例患者在发生转移疾病后开始ADT，43例患者在发生转移疾病前开始ADT；在这43例患者中，ADT期间发生转移疾病的中位时间为37.8个月。D0和D2患者从开始ADT到达到AI的中位时间分别为19.3个月和13.1个月。从开始ADT起的中位总生存期在D0和D2患者中分别为89.0个月和63.0个月，从达到AI起的中位总生存期在D0和D2患者中分别为63.1个月和44.2个月。这80例患者中，包括43例开始ADT时无转移疾病的患者，在前列腺癌达到AI后的中位生存期为54.8个月。
我们描述了最终发生转移的D0患者以及D2患者中AI前列腺癌的自然病史。结果表明AI前列腺癌患者的生存期比预期更长，据我们所知，这是第一项报告D0患者从ADT到发生转移疾病以及从AI到发生转移疾病时间的研究。这些结果可用于帮助设计D0前列腺癌患者的临床试验。
