Sartor O, Weinberger M, Moore A, Li A, Figg W D
Department of Urology, Louisiana State University Medical Center, Shreveport, USA.
Urology. 1998 Aug;52(2):252-6. doi: 10.1016/s0090-4295(98)00149-6.
To evaluate the effects of prednisone on prostate-specific antigen (PSA) in a cohort of patients with "hormone-refractory" prostate cancer.
Data were collected from 29 consecutive patients with hormone-refractory progressive prostate cancer who were treated with 10 mg of prednisone orally two times a day. Patients were included in this analysis only if other factors known to influence PSA levels (antiandrogen withdrawal, radiation, and/or other concomitant anticancer therapies) were definitively excluded as potentially confounding variables.
The mean and median PSA decline after initiating prednisone was 33% (95% confidence interval [CI] 20% to 46%) and 24% (range 0% to 99%), respectively. Ten patients (34%) had a PSA decline of more than 50% and 4 patients (14%) had PSA declines of more than 75%. The average and median time for progression-free survivals were 2.8 (95% CI 1.7 to 3.8) and 2.0 (range 0 to 11) months. Four (14%) patients had PSA declines lasting 6 months or more. Median survival was 12.8 months. Additional analyses indicated that a PSA decline of more than 50%, compared with less than 50%, was associated with a longer survival. Toxicities included steroid myopathy (n = 4), new-onset diabetes (n = 1), and dyspnea (n = 1).
Prednisone (10 mg orally two times a day) can decrease PSA by more than 50% in approximately one third of patients with hormone-refractory progressive prostate cancer. On the basis of comparisons with other data sets, we hypothesize a dose-response relationship between glucocorticoid dose and PSA decline.
评估泼尼松对一组“激素难治性”前列腺癌患者前列腺特异性抗原（PSA）的影响。
收集了29例连续的激素难治性进展性前列腺癌患者的数据，这些患者每天口服10毫克泼尼松，分两次服用。仅当已知会影响PSA水平的其他因素（抗雄激素撤药、放疗和/或其他同时进行的抗癌治疗）被明确排除为潜在混杂变量时，患者才纳入本分析。
开始使用泼尼松后，PSA的平均下降和中位数下降分别为33%（95%置信区间[CI] 20%至46%）和24%（范围0%至99%）。10例患者（34%）的PSA下降超过50%，4例患者（14%）的PSA下降超过75%。无进展生存期的平均和中位数时间分别为2.8（95% CI 1.7至3.8）个月和2.0（范围0至11）个月。4例（14%）患者的PSA下降持续6个月或更长时间。中位生存期为12.8个月。进一步分析表明，与PSA下降小于50%相比，PSA下降超过50%与更长的生存期相关。毒性反应包括类固醇肌病（n = 4）、新发糖尿病（n = 1）和呼吸困难（n = 1）。
泼尼松（每天口服10毫克，分两次）可使约三分之一的激素难治性进展性前列腺癌患者的PSA下降超过50%。基于与其他数据集的比较，我们推测糖皮质激素剂量与PSA下降之间存在剂量反应关系。
