Department of Urology, University Sapienza, Rome, Italy.
Urol Oncol. 2013 Jul;31(5):607-14. doi: 10.1016/j.urolonc.2011.05.005. Epub 2011 Jun 12.
To define characteristics of the first cycle of intermittent androgen deprivation (IAD) that would predict for outcomes in a long term follow-up.
In 1996 we started a prospective study of IAD for the treatment of biochemical progression (BP) after radical prostatectomy (RP) for prostate cancer (PC). The end-points of the trial were time to clinical progression (CP) and time to castration resistance PC (CRPC). Eighty-four cases were included in the study. In all cases, after an initial induction period, an acceptable nadir to switch from on-to-off-phase of IAD was considered to be a serum PSA < 1.0 ng/ml.
As possible predictors for time to CP and CRPC, we analyzed pretreatment parameters such as age, Gleason Score, serum PSA, testosterone, chromogranina A (CgA) levels, and characteristics from the first cycle of IAD.
Mean follow-up during IAD was 88.6 ± 16.7 months; 29.7% of patients developed CRPC and 14.2% of cases showed a CP with a mean time of 88.4 ± 14.3 months and 106.5 ± 20.6 months, respectively. At univariate and multivariate analysis, the PSA nadir during the first on-phase period and the first off-phase interval resulted in significant and independent predictors (P < 0.001) of the time to CRPC and CP. In particular for cases with a PSA nadir > 0.4 ng/ml and for those with an off-phase interval ≤ 24 weeks, the risk of CRPC and CP during IAD was 2.7-2.5 and 3.0-3.1 times that for patients with a PSA nadir ≤ 0.1 ng/ml and with an off-phase interval > 48 weeks, respectively.
Cases with BP after RP selected to IAD that show at the first cycle a PSA nadir ≤ 0.1 ng/ml and a off-phase interval ≥ 48 weeks may identify candidates who will experience better response to IAD treatments and delayed CP or CRPC development.
确定间歇雄激素剥夺治疗（IAD）的第一个周期的特征，这些特征可预测长期随访的结果。
1996 年，我们开始了一项前瞻性研究，研究 IAD 治疗前列腺癌（PC）根治性前列腺切除术后（RP）生化进展（BP）的疗效。该试验的终点是临床进展（CP）时间和去势抵抗性 PC（CRPC）时间。共有 84 例患者入组该研究。在所有病例中，在初始诱导期后，认为血清 PSA＜1.0ng/ml 是切换到 IAD 的开-关期的可接受的最低值。
作为 CP 和 CRPC 的时间的可能预测因子，我们分析了治疗前的参数，如年龄、Gleason 评分、血清 PSA、睾酮、嗜铬粒蛋白 A（CgA）水平以及 IAD 的第一个周期的特征。
IAD 期间的平均随访时间为 88.6±16.7 个月；29.7%的患者发生了 CRPC，14.2%的患者出现了 CP，平均时间分别为 88.4±14.3 个月和 106.5±20.6 个月。单因素和多因素分析表明，第一个开期和第一个关期 PSA 最低值是 CRPC 和 CP 时间的显著和独立的预测因子（P＜0.001）。特别是对于 PSA 最低值＞0.4ng/ml 的病例和关期间隔≤24 周的病例，IAD 期间发生 CRPC 和 CP 的风险分别是 PSA 最低值≤0.1ng/ml 和关期间隔＞48 周的病例的 2.7-2.5 倍和 3.0-3.1 倍。
RP 后选择 IAD 治疗的 BP 患者，如果在第一个周期中 PSA 最低值≤0.1ng/ml，且关期间隔≥48 周，可能确定出对 IAD 治疗反应更好、CP 或 CRPC 发展延迟的候选者。
