Amiya Yoshiyasu, Yamada Yasutaka, Sugiura Masahiro, Sasaki Makoto, Shima Takayuki, Suzuki Noriyuki, Nakatsu Hiroomi, Murakami Shino, Shimazaki Jun
Department of Urology, Asahi General Hospital, Asahi.
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Jpn J Clin Oncol. 2017 Mar 1;47(3):257-261. doi: 10.1093/jjco/hyw186.
Formerly, locally advanced prostate cancer exhibited poorly prognosis. In the late 1990s, new surgical and radiation technologies were introduced in combination with androgen deprivation. To evaluate respective strategies, outcomes were examined.
Between 2001 and 2010, 224 patients with T3N0M0 (10.9% of all prostate cancer cases) were treated with prostatectomy, external beam radiation therapy with/without androgen deprivation or hormone alone. Complete records were obtained by the end of 2015.
Operation group first started without adjuvant treatment and prostate-specific antigen (PSA) relapse occurred in 39% of cases. Radiation therapy group was alternatively divided into two subgroups, that received either monotherapy or combination with androgen deprivation, and PSA relapse rates were 65 and 16%, respectively. High rates of PSA relapse in both the operation and radiation therapy groups were observed in patients without adjuvant therapy, but after relapse androgen deprivation proceeded favorable outcomes. In the radiation subgroups, PSA relapse rates were different, but both subsequent survival rates were the same. This may be due to the effect of androgen deprivation after relapse, indicating effect of delayed therapy. PSA relapse rate in the hormone therapy group was 25% and after relapse, patients applied to treatment with other hormonal and anticancer drugs. Overall survival rates were 91, 88 and 67% in the operation, radiation therapy and hormone therapy groups, respectively.
Aggressive treatment with short-term androgen deprivation for locally advanced prostate cancer could be beneficial and not harmful when suitable candidates are selected. Delayed androgen deprivation was effective for no adjuvant patients after PSA relapse.
以前，局部晚期前列腺癌预后较差。在20世纪90年代后期，新的手术和放疗技术与雄激素剥夺疗法联合应用。为评估各自的治疗策略，对治疗结果进行了检查。
2001年至2010年间，224例T3N0M0患者（占所有前列腺癌病例的10.9%）接受了前列腺切除术、有或无雄激素剥夺的外照射放疗或单纯激素治疗。到2015年底获得了完整记录。
手术组最初未进行辅助治疗，39%的病例出现前列腺特异性抗原（PSA）复发。放疗组又分为两个亚组，分别接受单一疗法或与雄激素剥夺联合治疗，PSA复发率分别为65%和16%。在未接受辅助治疗的患者中，手术组和放疗组的PSA复发率均较高，但复发后进行雄激素剥夺可取得良好效果。在放疗亚组中，PSA复发率不同，但随后的生存率相同。这可能是由于复发后雄激素剥夺的作用，表明延迟治疗的效果。激素治疗组的PSA复发率为25%，复发后患者应用其他激素和抗癌药物进行治疗。手术组（91%）、放疗组（88%）和激素治疗组（67%）的总生存率分别为91%、88%和67%。
对于局部晚期前列腺癌，选择合适的患者进行短期雄激素剥夺的积极治疗可能有益而无害。PSA复发后，延迟雄激素剥夺对未接受辅助治疗的患者有效。
