Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
Department of Urology, Nakatsu Daiichi Hospital, 252-2 Miyabu, Nakatsu, Oita, 871-0012, Japan.
Int Urol Nephrol. 2020 Jan;52(1):77-85. doi: 10.1007/s11255-019-02281-4. Epub 2019 Sep 24.
There are no criteria for administering first- or second-generation anti-androgens (FGA and SGA, respectively) to patients with non-metastatic castration-resistant prostate cancer (nmCRPC). This study aimed to assess the efficacy of alternative FGA therapy in nmCRPC patients and the prognosis of these patients and to identify factors for predicting patients potentially responsive to FGA.
Data from 63 men with nmCRPC who underwent alternative FGA therapy (bicalutamide, flutamide, or chlormadinone acetate) as first-line therapy after failure of primary androgen-deprivation therapy (PADT) between 2004 and 2017 at Hiroshima University Hospital and affiliated hospitals were retrospectively investigated. The associations of clinicopathological parameters with overall survival (OS) and prostate-specific antigen (PSA) progression-free survival (PFS) of alternative FGA-treated patients were analyzed.
Time to CRPC [p = 0.007, hazard ratio (HR) = 4.77], regional lymph node involvement at the diagnosis of CRPC (p = 0.022, HR = 2.42), and PSA-PFS of alternative FGA therapy ≤ 6 months (p = 0.020, HR = 2.39) were identified as prognostic factors using a multivariate analysis. Additionally, Cox proportional hazard models revealed that PSA nadir value > 1 ng/mL during PADT (p = 0.034, HR = 2.40) and time from starting PADT to PSA nadir ≤ 1 year (p = 0.047, HR = 1.85) were predictive factors for worse PSA-PFS in alternative FGA therapy.
Shorter time to CRPC, regional lymph node involvement, PSA nadir during PADT > 1 ng/mL, and time from starting PADT to PSA nadir ≤ 1 year might suggest the potential benefit of immediate commencement of SGA, compared to FGA administration after nmCRPC diagnosis.
对于非转移性去势抵抗性前列腺癌（nmCRPC）患者，尚无给予第一代或第二代抗雄激素药物（分别为 FGA 和 SGA）的标准。本研究旨在评估 nmCRPC 患者接受替代 FGA 治疗的疗效和这些患者的预后，并确定预测患者对 FGA 反应的因素。
回顾性分析 2004 年至 2017 年期间广岛大学医院及其附属医院的 63 例 nmCRPC 患者的临床病理资料，这些患者在原发性去势治疗（PADT）失败后接受替代 FGA 治疗（比卡鲁胺、氟他胺或氯米芬醋酸酯）作为一线治疗。分析临床病理参数与替代 FGA 治疗患者的总生存（OS）和前列腺特异性抗原（PSA）无进展生存（PFS）的关系。
采用多变量分析发现，CRPC 发生时间（p=0.007，HR=4.77）、CRPC 诊断时区域淋巴结受累（p=0.022，HR=2.42）和替代 FGA 治疗 PSA-PFS 时间≤6 个月（p=0.020，HR=2.39）是预后因素。此外，Cox 比例风险模型显示，PADT 期间 PSA 最低值>1ng/mL（p=0.034，HR=2.40）和从开始 PADT 到 PSA 最低值≤1 年的时间（p=0.047，HR=1.85）是替代 FGA 治疗中 PSA-PFS 较差的预测因素。
CRPC 发生时间较短、区域淋巴结受累、PADT 期间 PSA 最低值>1ng/mL 和从开始 PADT 到 PSA 最低值≤1 年的时间可能提示在 nmCRPC 诊断后立即开始 SGA 治疗可能更有益。
