Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Prostate Cancer Prostatic Dis. 2012 Mar;15(1):75-86. doi: 10.1038/pcan.2011.47. Epub 2011 Oct 11.
In the era when various treatment agents for advanced-stage prostate cancer are available, it is important to investigate overall survival for metastatic prostate cancer treated with step-up hormonal treatment as a reference against new treatment regimens, including antitumor agents and/or new hormonal derivatives, and it is desirable to explore pretreatment, biopsy-related and post-treatment prognostic factors to establish tailor-made treatment strategies.
Between 1992 and 2002, 94 patients were diagnosed with prostate cancer with distant metastases in our facility. Various pretreatment clinical findings including serum PSA, testosterone, alkaline phosphatase (ALP), digital rectal examination (DRE) and extension of disease score were investigated for predicting outcomes in step-up hormonal treatment. We also investigated the impact of pathological findings including Gleason grading, tumor volume indices, various Gleason grade 5 volume indices in biopsy specimens, and post-treatment PSA nadir following step-up hormonal treatment on overall survival.
The 3- and 5-year overall survival was 72.4% and 62.5%, respectively. According to univariate analyses, patients with PSA ≤ 100 ng ml(-1), ALP <440 IU l(-1), T1c to T3 on DRE, extension of disease (EOD) score 0-3, no Gleason grade 5 cancer in biopsy specimens or less such cancer and good response at any stage of hormonal therapy had significantly better overall survival than did patients with alternative status. A multivariate Cox proportional hazard model revealed that PSA nadir after first-line hormonal treatment, PSA nadir after second-line treatment and Gleason grade 5 volume index were independent prognostic factors.
Even in very advanced prostate cancer, local pathological indices, a Gleason grade 5 volume index in particular, could differentiate patients with better prognosis from worse prognosis. Step-up hormonal therapy including luteinizing hormone-releasing hormone agonist, estrogen derivatives and steroid hormones may be valuable in patients with metastatic prostate cancer, especially in good responders at any stage of hormonal therapy.
在有多种晚期前列腺癌治疗药物的时代，研究采用逐步升阶梯式激素治疗转移性前列腺癌的总生存率很重要，该方法可作为新治疗方案（包括抗肿瘤药物和/或新型激素药物）的参考，并且需要探索预处理、活检相关和治疗后预后因素，以制定个体化的治疗策略。
1992 年至 2002 年期间，我院共诊断 94 例有远处转移的前列腺癌患者。我们研究了各种预处理的临床发现，包括血清 PSA、睾酮、碱性磷酸酶（ALP）、直肠指检（DRE）和疾病扩展评分，以预测升阶梯式激素治疗的结果。我们还研究了病理发现的影响，包括 Gleason 分级、肿瘤体积指数、活检标本中各种 Gleason 分级 5 体积指数以及升阶梯式激素治疗后 PSA 最低值对总生存率的影响。
3 年和 5 年总生存率分别为 72.4%和 62.5%。根据单因素分析，PSA≤100ng/ml、ALP<440IU/l、DRE 上 T1c 至 T3、疾病扩展评分 0-3、活检标本中无 Gleason 分级 5 癌或仅有少量此类癌症以及任何阶段激素治疗有良好反应的患者，其总生存率显著高于其他患者。多因素 Cox 比例风险模型显示，一线激素治疗后的 PSA 最低值、二线治疗后的 PSA 最低值和 Gleason 分级 5 体积指数是独立的预后因素。
即使在晚期前列腺癌中，局部病理指标，特别是 Gleason 分级 5 体积指数，也可以区分预后较好和较差的患者。包括促黄体激素释放激素激动剂、雌激素衍生物和甾体激素在内的升阶梯式激素治疗可能对转移性前列腺癌患者有价值，尤其是在任何阶段激素治疗均有良好反应的患者。
