Bruchovsky Nicholas, Klotz Laurence, Crook Juanita, Phillips Norman, Abersbach Jonas, Goldenberg S Larry
The Prostate Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Canada.
Clin Genitourin Cancer. 2008 Mar;6(1):46-52. doi: 10.3816/CGC.2008.n.008.
Observations of quality of life (QOL), morbidity, and mortality were obtained from the results of a prospective phase II study of intermittent androgen suppression for recurrent prostate cancer after radiation therapy.
Patients with histologically confirmed adenocarcinoma of the prostate and a rising serum prostate-specific antigen level after external-beam radiation of the prostate were treated intermittently with a 36-week course of cyproterone and leuprolide. At predetermined intervals, QOL was assessed using the Southwest Oncology Group 9346 QOL and the American Urological Association symptom score questionnaires. Progression-free and overall survival rates were estimated using the Kaplan-Meier method. Parameters related to progression were explored with univariate and multivariate analyses.
The incidence of adverse events was higher when patients were on treatment. Fatigue, dyspnea, and hematuria were the most common symptoms and signs recorded (50.5%, 24.8%, and 17.4%, respectively). Less frequent were myocardial infarction (7.3%), cerebrovascular accident (6.4%), and deep vein thrombosis (5.5%). Quality of life improved when off treatment, as indicated by a shift toward baseline levels in the scales depicting physical and work functions, hot flashes, impotence, sexual performance, urgency, and nocturia. Biochemical recurrence-free survival at 5 years was 70%, with a median > 6 years. The overall 5-year survival was 80%, similar to that of an age-matched population of normal men.
Intermittent androgen suppression is a potentially useful treatment for locally recurrent prostate cancer after radiation therapy with QOL benefits in the off-treatment interval and no apparent deleterious effects on short- to medium-term survival.
生活质量（QOL）、发病率和死亡率的观察结果来自一项关于放疗后复发性前列腺癌间歇性雄激素抑制的前瞻性II期研究。
组织学确诊为前列腺腺癌且前列腺外照射后血清前列腺特异性抗原水平升高的患者，接受了为期36周的环丙孕酮和亮丙瑞林间歇性治疗。在预定的时间间隔，使用西南肿瘤学组9346 QOL问卷和美国泌尿外科学会症状评分问卷评估生活质量。采用Kaplan-Meier法估计无进展生存率和总生存率。通过单因素和多因素分析探索与进展相关的参数。
患者接受治疗时不良事件的发生率较高。疲劳、呼吸困难和血尿是记录到的最常见症状和体征（分别为50.5%、24.8%和17.4%）。心肌梗死（7.3%）、脑血管意外（6.4%）和深静脉血栓形成（5.5%）的发生率较低。在未接受治疗时生活质量有所改善，这表现为在描述身体和工作功能、潮热、阳痿、性功能、尿急和夜尿的量表中向基线水平转变。5年无生化复发生存率为70%，中位生存期>6年。总体5年生存率为80%，与年龄匹配的正常男性人群相似。
间歇性雄激素抑制对于放疗后局部复发性前列腺癌是一种潜在有用的治疗方法，在未治疗期间可改善生活质量，且对短期至中期生存无明显有害影响。
