Komiya Akira, Shimbo Masaki, Suzuki Hiroyoshi, Imamoto Takashi, Kato Tomonori, Fukasawa Satoshi, Kamiya Naoto, Naya Yukio, Mori Ikuo, Ichikawa Tomohiko
Department of Urology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677.
Oncol Lett. 2010 Jan;1(1):73-79. doi: 10.3892/ol_00000013. Epub 2010 Jan 1.
We retrospectively evaluated the outcome of oral low-dose dexamethasone (DXM) therapy for androgen-independent prostate cancer (AIPC). Between January 1999 and April 2006, 99 consecutive patients with AIPC were enrolled in this study. The median patient age was 70 years (range 46-86), and the median pretreatment prostate-specific antigen (PSA) level was 243 ng/ml (range 8.2-29600). Median follow-up was 41.9 months (range 11.4-170.4). Upon biochemical failure, patients were treated with oral low-dose DXM. A total of 40 of the 99 cases (40.4%) showed a ≥50% decrease in serum PSA levels (PSA responders). Twenty-five cases (25.2%) showed a <50% decrease in PSA, and the remaining 34 cases (34.3%) had increased PSA levels (PSA non-responders). The median PSA progression-free survival was 3.0 (range 0-27) and 8.0 months (range 2-27) for the entire cohort and PSA responders, respectively. The PSA responders had a significantly increased survival (median 30.1 months) compared to the non-responders (median 8.8 months, P<0.001). Of the 34 patients who were under pain control for bone metastases before the administration of DXM, 23 (67.6%) were able to discontinue the regular use of analgesics. The PSA responders also showed an increase in hemoglobin levels. The change in serum interleukin-6 levels was significantly associated with a response to DXM (P=0.0065). Severe adverse events of DXM were rare. Clinicopathological factors predicting the PSA response to DXM were age, time from initial androgen deprivation therapy to DXM and PSA velocity prior to DXM. In conclusion, oral low-dose DXM led to an acceptable PSA response in patients with AIPC. Thus, this therapy may be an effective and safe alternative for the treatment of AIPC, particularly for patients who are not favourable candidates for chemotherapy.
我们回顾性评估了口服低剂量地塞米松（DXM）治疗去势抵抗性前列腺癌（AIPC）的疗效。1999年1月至2006年4月期间，本研究连续纳入了99例AIPC患者。患者年龄中位数为70岁（范围46 - 86岁），治疗前前列腺特异性抗原（PSA）水平中位数为243 ng/ml（范围8.2 - 29600）。中位随访时间为41.9个月（范围11.4 - 170.4个月）。在生化失败时，患者接受口服低剂量DXM治疗。99例患者中共有40例（40.4%）血清PSA水平下降≥50%（PSA反应者）。25例（25.2%）患者PSA下降<50%，其余34例（34.3%）患者PSA水平升高（PSA无反应者）。整个队列和PSA反应者的PSA无进展生存期中位数分别为3.0个月（范围0 - 27个月）和8.0个月（范围2 - 27个月）。与无反应者（中位数8.8个月，P<0.001）相比，PSA反应者的生存期显著延长（中位数30.1个月）。在接受DXM治疗前骨转移疼痛得到控制的34例患者中，23例（67.6%）能够停止常规使用镇痛药。PSA反应者的血红蛋白水平也有所升高。血清白细胞介素-6水平的变化与对DXM的反应显著相关（P = 0.0065）。DXM的严重不良事件很少见。预测对DXM的PSA反应的临床病理因素包括年龄、从初始雄激素剥夺治疗到使用DXM的时间以及DXM治疗前的PSA速度。总之，口服低剂量DXM使AIPC患者获得了可接受的PSA反应。因此，这种治疗方法可能是治疗AIPC的一种有效且安全的替代方法，特别是对于不适合化疗的患者。
