Departamento de Urología, Hospital Universitario Central de Asturias, Oviedo, España.
Departamento de Urología, Hospital Universitario Central de Asturias, Oviedo, España.
Actas Urol Esp (Engl Ed). 2020 Apr;44(3):156-163. doi: 10.1016/j.acuro.2019.06.006. Epub 2020 Feb 26.
The effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series).
Patients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry.
703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments.
A longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance.
原发去势治疗（ADT）对局限性前列腺癌（PCa）患者的疗效尚未得到充分证实。本研究旨在分析西班牙前列腺癌登记处（该系列的 19.4%）中采用 ADT 作为主要治疗方法的肿瘤结局。
患者分为三组：1）低/中危局限性肿瘤；2）高危且局部进展（T3-4）肿瘤；3）转移性肿瘤。分析去势抵抗时间和总癌症特异性生存情况。在非转移性肿瘤中，将接受 ADT 治疗的患者的生存情况与西班牙前列腺癌登记处局部治疗患者的数据进行比较。
分析了 703 例病例。转移性肿瘤组的去势抵抗时间明显较短。随访期间，179 例死亡（25.5%），其中 89 例（12.6%）死于 PCa。ADT 治疗 3 年后，第 1 组中仅有 14.6%的患者死亡（1%死于 PCa），第 2 组为 20.5%，第 3 组为 46.8%（分别为 9.2%和 31.3%死于 PCa）。与根治性前列腺切除术或放疗相比，第 1 组接受 ADT 治疗的患者癌症特异性生存率显著更差。在高危和局部进展性肿瘤中，ADT 治疗的癌症特异性生存率也低于局部治疗。
采用 ADT 治疗的低危和中危局限性肿瘤患者出现去势抵抗的时间更长。转移性肿瘤患者出现去势抵抗的时间最短。
