Fujimoto Naohiro, Kubo Tatsuhiko, Tomisaki Ikko
Department of Urology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
Department of Public Health, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
Clin Genitourin Cancer. 2015 Aug;13(4):359-363. doi: 10.1016/j.clgc.2015.02.013. Epub 2015 Mar 5.
Substantial numbers of men with localized prostate cancer undergo long-term primary androgen deprivation therapy (ADT). Whether long-term ADT is required for patients with localized prostate cancer, especially elderly men, remains unknown. In the present study, we explored the possibility of ADT cessation after a favorable response to primary ADT in patients with localized prostate cancer.
We retrospectively reviewed men with localized prostate cancer who had achieved a good initial response to primary ADT and stopped it thereafter. Prostate-specific antigen (PSA) recurrence was defined as 2 consecutive increases > 4 ng/mL. A total of 34 patients (age, 62-89 years) were followed up for > 24 months after ADT cessation.
The ADT duration and follow-up period after ADT cessation was 10 to 162 months (median, 33.5 months) and 24 to 95 months (median, 37 months), respectively. PSA recurrence was observed in 10 of 34 patients (29.4%), and the 5-year PSA progression-free rate was 66.2%. PSA recurrence was observed in 100% (6 of 6) and 14.3% (4 of 28) of men who had received ADT for < 16 months and > 16 months, respectively. ADT was reinstated in 5 patients after PSA recurrence; and their PSA levels declined rapidly, and no clinical progression was observed. The 5-year overall and disease-specific survival rate was 65.1% and 100%, respectively.
ADT can be stopped for men with localized prostate cancer, especially elderly men, after a favorable response to primary ADT.
大量局限性前列腺癌男性患者接受长期的初始雄激素剥夺治疗（ADT）。对于局限性前列腺癌患者，尤其是老年男性患者，是否需要长期进行ADT尚不清楚。在本研究中，我们探讨了局限性前列腺癌患者在对初始ADT产生良好反应后停止ADT的可能性。
我们回顾性分析了对初始ADT产生良好反应并随后停止治疗的局限性前列腺癌男性患者。前列腺特异性抗原（PSA）复发定义为连续两次升高>4 ng/mL。共有34例患者（年龄62 - 89岁）在停止ADT后随访超过24个月。
ADT持续时间及停止ADT后的随访时间分别为10至162个月（中位数33.5个月）和24至95个月（中位数37个月）。34例患者中有10例（29.4%）出现PSA复发，5年无PSA进展率为66.2%。接受ADT时间<16个月和>16个月的男性患者中，PSA复发率分别为100%（6/6）和14.3%（4/28）。5例患者在PSA复发后恢复ADT治疗；他们的PSA水平迅速下降，且未观察到临床进展。5年总生存率和疾病特异性生存率分别为65.1%和100%。
对于局限性前列腺癌男性患者，尤其是老年男性患者，在对初始ADT产生良好反应后可以停止ADT。
