Ueno Satoru, Namiki Mikio, Fukagai Takashi, Ehara Hidetoshi, Usami Michiyuki, Akaza Hideyuki
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Int J Urol. 2006 Dec;13(12):1494-500. doi: 10.1111/j.1442-2042.2006.01604.x.
A retrospective review of patients with localized and locally advanced prostate cancer was performed to evaluate the efficacy of primary hormonal therapy and predict long-term prognosis in these patients.
A total of 628 patients who were diagnosed with stage T1c to T3 prostate cancer were treated with primary hormonal therapy at participating institutions. The patients were classified based on pretreatment prostate-specific antigen (PSA) level, Gleason score, and time to nadir PSA level. Disease-specific and progression-free survival rates were investigated, and compared among the subgroups.
The mean age of patients was 74.5 years, and median pretreatment PSA level was 14.0 ng/mL. A total of 399 patients (63.5%) were treated with combined androgen blockade (CAB), and 229 patients (36.5%) were treated with castration monotherapy. The disease-specific survival rate of all 628 patients was 89.1% at 8 years. The group that showed a good response to primary hormonal therapy (Group G, pretreatment PSA level < or =20 ng/mL, Gleason score < or =7, and time to nadir PSA < or =6 months) accounted for approximately one-third of the total number of T1c-T3 patients. Disease-specific and progression-free survival rates at 8 years in Group G were 98.9% and 82.0%, respectively. These rates increased to 100% and 87.3%, respectively, in patients receiving CAB treatment in Group G.
The results indicate the usefulness of primary hormonal therapy, especially CAB treatment, for patients showing a good response to hormonal therapy in long-term control of localized and locally advanced prostate cancer.
对局限性和局部进展性前列腺癌患者进行回顾性研究，以评估初始激素治疗的疗效并预测这些患者的长期预后。
共有628例被诊断为T1c至T3期前列腺癌的患者在参与研究的机构接受了初始激素治疗。根据治疗前前列腺特异性抗原（PSA）水平、 Gleason评分以及达到最低PSA水平的时间对患者进行分类。研究疾病特异性生存率和无进展生存率，并在各亚组之间进行比较。
患者的平均年龄为74.5岁，治疗前PSA水平中位数为14.0 ng/mL。共有399例患者（63.5%）接受了联合雄激素阻断（CAB）治疗，229例患者（36.5%）接受了去势单一疗法。628例患者的8年疾病特异性生存率为89.1%。对初始激素治疗反应良好的组（G组，治疗前PSA水平≤20 ng/mL，Gleason评分≤7，达到最低PSA水平的时间≤6个月）约占T1c - T3期患者总数的三分之一。G组8年的疾病特异性生存率和无进展生存率分别为98.9%和82.0%。在G组接受CAB治疗的患者中，这些比率分别升至100%和87.3%。
结果表明，初始激素治疗，尤其是CAB治疗，对于对激素治疗反应良好的患者在局限性和局部进展性前列腺癌的长期控制中是有用的。
