Sureka Sanjoy Kumar, Maheshwari Ruchir, Agnihotri Shalini, Mitash Nilay, Ahmad Shamim, Mandhani Anil
Department of Urology & Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Urology, Apex Hospitals, Jaipur, India.
Indian J Med Res. 2016 May;143(Supplement):S68-S73. doi: 10.4103/0971-5916.191783.
BACKGROUND & OBJECTIVES: There is lack of data on natural history and progression of prostate cancer (PC) which have implications in the management of the disease. We undertook this retrospective study to analyze factors predicting progression of metastatic PC to castration-resistant prostate cancer (CRPC) in Indian men.
Complete records of 223 of the 489 patients with metastatic PC were obtained from computerized data based system in a tertiary care hospital in north India between January 2000 to June 2012. Patients with follow up of < 6 months were excluded. Age (≤ and > 65 yr), baseline PSA (< and ≥ 50 ng/ml), bone scan and Gleason score (≤7 and >7) were recorded. Extent of bone disease (EOD) was stratified according to the number of bone lesions i.e., < 5, 5-10, > 10. CRPC was defined as two consecutive PSA rise of > 50 per cent from nadir or an absolute value of > 5 ng/ml.
Mean age of patients was 61.5 ± 12.45 yr and their PSA level was 325.6 ± 631.35 ng/dl. Of the 223 patients, 193 (86%) progressed to CRPC at median time of 10.7 (4-124) months. Median follow up was 24 (6-137) months. On univariate and multivariate analyses EOD on bone scan was found to be a significant predictor ( P=0.006) for time to CRPC. Median time to CRPC was 10 months (CI 95%, 7.5-12.48) with >10 lesions or super scan versus 16 months (CI 95%, 10.3-21.6) with <10 bone lesion (P=0.01). Ninety (46.6 %) patients of CRPC died with median time to death from time of CRPC 21 (10-120) months.
INTERPRETATION & CONCLUSIONS: Median time for progression of metastatic PC to CRPC ranged from 10-16 months depending on the extent of the bone involvement. In Indians, the aggressive course of advanced prostate cancer warrants further clinical trials to explore the need for additional treatment along with initial castration.
前列腺癌（PC）自然病史和病程的数据匮乏，这对该疾病的管理具有重要意义。我们开展这项回顾性研究，以分析预测印度男性转移性PC进展为去势抵抗性前列腺癌（CRPC）的因素。
从印度北部一家三级护理医院的计算机化数据系统中获取了489例转移性PC患者中223例的完整记录，时间跨度为2000年1月至2012年6月。排除随访时间<6个月的患者。记录年龄（≤65岁和>65岁）、基线PSA（<50 ng/ml和≥50 ng/ml）、骨扫描和Gleason评分（≤7和>7）。根据骨病变数量对骨病范围（EOD）进行分层，即<5个、5 - 10个、>10个。CRPC定义为PSA从最低点连续两次升高>50%或绝对值>5 ng/ml。
患者的平均年龄为61.5±12.45岁，PSA水平为325.6±631.35 ng/dl。在223例患者中，193例（86%）在中位时间10.7（4 - 124）个月时进展为CRPC。中位随访时间为24（6 - 137）个月。单因素和多因素分析发现，骨扫描的EOD是CRPC发生时间的显著预测因素（P = 0.006）。骨病变>10个或全身骨显像的患者进展为CRPC的中位时间为10个月（95%CI，7.5 - 12.48），而骨病变<10个的患者为16个月（95%CI，10.3 - 21.6）（P = 0.01）。90例（46.6%）CRPC患者死亡，从CRPC发生到死亡的中位时间为21（10 - 120）个月。
转移性PC进展为CRPC的中位时间为10 - 16个月，取决于骨受累程度。在印度人当中，晚期前列腺癌的侵袭性病程需要进一步开展临床试验，以探索在初始去势治疗的基础上是否需要额外治疗。
