Department of Genitourinary Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060, China,
Cancer Chemother Pharmacol. 2013 Nov;72(5):1055-61. doi: 10.1007/s00280-013-2291-x. Epub 2013 Sep 17.
To evaluate whether changes in fPSA level could predict tPSA flare-up in patients with castration-refractory prostate cancer during the initial phase of docetaxel-based chemotherapy.
We retrospectively identified 79 consecutive patients who received docetaxel-based chemotherapy at our institution. The treatment protocols included docetaxel 75 mg/m² every 21 days, with either prednisone 5 mg twice daily or estramustine 280 mg three times daily on days 1-5; treatment with dexamethasone preceded docetaxel therapy. All PSA values were determined before every cycle of docetaxel-based treatment.
According to changes in tPSA level, 79 patients were divided into 3 groups: response (group 1), progression (group 2) and flare-up (group 3). fPSA and tPSA levels showed different patterns in groups 1, 2 and 3. Changes in fPSA level were independent of the changes in tPSA level in group 3, which decreased during chemotherapy. However, comparing with fPSA changes in group 3, changes in fPSA level were in accordance with tPSA changes in groups 1 and 2. Estimated median survival in groups 1, 2 and 3 was 23, 13 and 21 months, respectively. Median survival for patients in groups 1 (P = 0.008 vs group 2) and 3 (P = 0.029 vs group 2) is significantly longer than for patients who experienced progressive disease under therapy. However, there was no statistically significant difference in survival between groups 1 and 3.
In the present study, we observed that changes in fPSA level could possibly discriminate tPSA flare-up from tPSA progression in patients with castration-refractory prostate cancer during the initial phase of docetaxel-based chemotherapy.
评估游离前列腺特异性抗原（fPSA）水平的变化是否可预测接受多西紫杉醇为基础化疗的去势抵抗性前列腺癌（CRPC）患者在初始阶段中总前列腺特异性抗原（tPSA）的flare-up（一过性升高）。
我们回顾性地确定了 79 例在我院接受多西紫杉醇为基础化疗的连续患者。治疗方案包括多西紫杉醇 75mg/m²，每 21 天一次，泼尼松 5mg，每日两次或雌莫司汀 280mg，每日三次，于第 1-5 天给药；多西紫杉醇治疗前先给予地塞米松。所有 PSA 值均在每周期的多西紫杉醇治疗前确定。
根据 tPSA 水平的变化，79 例患者被分为 3 组：缓解（组 1）、进展（组 2）和 flare-up（组 3）。组 1、2 和 3 的 fPSA 和 tPSA 水平呈现不同的模式。组 3 中 fPSA 水平的变化与 tPSA 水平的变化无关，在化疗期间下降。然而，与组 3 的 fPSA 变化相比，组 1 和 2 的 fPSA 变化与 tPSA 变化一致。组 1、2 和 3 的估计中位生存期分别为 23、13 和 21 个月。组 1（P = 0.008 比组 2）和 3（P = 0.029 比组 2）的患者中位生存期明显长于治疗中进展的患者。然而，组 1 和 3 之间的生存无统计学差异。
在本研究中，我们观察到在接受多西紫杉醇为基础化疗的 CRPC 患者初始阶段中，fPSA 水平的变化可能可以区分 tPSA 的 flare-up 与 tPSA 的进展。
