前列腺癌内分泌治疗后无进展生存期的影响因素分析

目的:前列腺癌内分泌治疗后发现进展速度存在较大差异,为了改善其预后,本文探讨前列腺癌内分泌治疗后无进展生存期的影响因素。方法:回顾性分析116例接受内分泌治疗的前列腺癌患者的临床病理资料,对各临床病理因素之间进行Spearman等级相关分析,对各临床病理因素分别进行单因素分析(log-rank检验),应用Cox比例风险模型进行多因素统计分析。结果:Cox比例风险模型发现有统计学意义的因素为Gleason评分(P<0.01)和临床分期(P<0.01)。Gleason评分每增加1个单位量,内分泌治疗后发生进展的风险将增加为原来的2.126倍,临床分期每增加1个单位量,内分泌治疗后发生进展的风险将增加为原来的6.625倍。治疗前的血清总PSA水平分别与临床分期(P<0.01)、Gleason评分(P<0.01)都存在等级相关。结论:临床分期和Gleason评分是影响前列腺癌内分泌治疗后无进展生存期的重要因素。     

伴骨转移前列腺癌患者在内分泌治疗前长期小剂量口服阿司匹林的抗癌作用研究

目的:观察伴骨转移的前列腺癌患者在内分泌治疗前长期、小剂量口服阿司匹林有无抑制前列腺癌进展的作用。方法:回顾性分析2005年1月～2013年5月在我院接受内分泌治疗的初诊伴骨转移的前列腺癌患者的临床资料,将内分泌治疗前长期(≥1年)、小剂量(100 mg/d)口服阿司匹林的29例患者纳入阿司匹林组,未口服阿司匹林的167例患者纳入非阿司匹林组。收集两组患者内分泌治疗前、后的相关临床资料;统计内分泌治疗后1年内两组各有多少患者进展到去势抵抗前列腺癌(castration resistant prostate cancer,CRPC)阶段;统计内分泌治疗后5年内两组患者的肿瘤特异性死亡率。结果:内分泌治疗前,阿司匹林组患者中患有冠心病、脑梗塞比例更高;而两组患者的其他指标,如年龄、Gleason评分、血PSA值、TNM分期等比较差异无统计学意义(P0.05)。阿司匹林组和非阿司匹林组患者内分泌治疗后1年的C反应蛋白(CRP)较内分泌治疗前均显著升高(P=0.002,P=0.000),而两组患者比较差异无统计学意义(P=0.756)。两组患者的早期CRPC发生率比较差异无统计学意义(27.6%vs.34.1%,P=0.490)。内分泌治疗后5年内,两组患者的前列腺癌特异性死亡率比较差异无统计学意义[75.9%(22/29) vs.78.4%(131/167),P=0.757]。结论:伴有骨转移的前列腺癌患者,在接受内分泌治疗前,长期、小剂量口服阿司匹林并无延缓前列腺癌进展的作用。     

新辅助内分泌治疗对临床局限性前列腺癌手术病理和生化复发的影响

目的 了解新辅助内分泌治疗(NHT)对临床局限性前列腺癌手术病理和生化复发的影响.方法 经直肠前列腺穿刺活检确诊的52例临床局限性前列腺癌患者,分为联合治疗组(NHT之后行手术治疗,26例)和单纯手术组(26例),均由同一医师行开放性经耻骨后根治性前列腺切除术.统计2组手术时间、出血量、术后住院时间、PSA水平、穿刺组织和手术标本的Gleason评分、临床分期和病理分期及无生化复发生存率.用独立样本t检验比较2组手术时间、出血量、术后住院时间及PSA水平.用秩和检验比较2组穿刺和术后病理的Gleason评分、临床分期和病理分期.用配对t检验比较联合治疗组NHT治疗前后PSA水平的变化.用配对秩和检验比较穿刺组织和手术标本分期和Gleason评分的变化.用Fisher精确概率法比较2组Gleason评分和分期变化的比例.用Kaplan-Meier法分析术后无生化复发生存率.结果 联合治疗组和单纯手术组平均手术时间分别为184.3、183.2 min,平均出血量分别为1275.0、1411.5 ml,平均术后住院时间分别为10.1、13.2 d,2组比较差异均无统计学意义(P＞0.05).就诊时的平均PSA水平分别为28.11、18.40ng/ml(P＞0.05),联合治疗组患者经平均6.58个月NHT治疗后.平均PSA水平降至0.53 ng/ml(P＜0.01).联合治疗组穿刺组织和手术标本平均Gleason评分分别为7.46和7.62(P＞0.05),单纯手术组分别为6.46和7.31(P＜0.01).联合治疗组穿刺Gleason评分高于单纯手术组(P＜0.05),而2组手术标本Glesaon评分比较差异无统计学意义(P＞0.05).联合治疗组临床分期为T2 12例(46%)、T3 14例(54%),单纯手术组T1 1例(4%)、T2 21例(81%)、T3 4例(15%),2组比较差异有统计学意义(P＜0.01).联合治疗组病理分期T2 19例(73%),T3 7例(27%),单纯手术组T2 19例(73%)、T3 7例(27%),2组比较差异无统计学意义(P＞0.05).联合治疗组病理分期低于临床分期(P＜0.01),单纯手术组的病理分期和临床分期差异无统计学意义(P＞0.05).随访2～81个月,2组分别平均随访时间29.4、31.4个月.2组的1年无生化复发率分别为71%(10/14)和80%(16/20,P＞0.05),2年无生化复发率为56%(5/9)和60%(9/15,P＞0.05).结论 NHT治疗不会增加临床局限性前列腺癌患者的手术风险.对患者术后病理分期与Gleason评分有一定改善,对术后无生化复发生存率可能有积极影响.     

放射性粒子植入术治疗高分级前列腺癌的远期随访研究

目的:探讨应用I125放射性粒子植入术治疗高分级非转移性前列腺癌的远期疗效和安全性。方法:回顾性分析2007年1月~2017年3月经病理确诊为前列腺癌且Gleason评分≥8分的高分级前列腺癌患者67例,年龄61~83岁,平均(74.2±4.8)岁;穿刺前PSA 5.6~117.0ng/ml,平均(27.6±22.8)ng/ml;穿刺Gleason评分8分者35例(52.2%),9~10分者32例(47.8%);临床分期T2期42例(62.7%),T3期25例(37.3%),所有患者均接受I125前列腺放射性粒子植入术作为初始治疗,术后均行辅助内分泌治疗,内分泌治疗时间为6~12个月,为激素全阻断疗法。生化进展定义为PSA大于治疗后最低值2ng/ml,随访患者无生化进展生存率、肿瘤特异性生存率和总体生存率。结果:所有高分级前列腺癌患者粒子植入手术均顺利完成,术后随访12~121个月,平均56.1个月。在随访过程中,33例(49.3%)高分级前列腺癌患者出现生化进展,平均生化进展时间为28.8个月;13例(19.4%)患者在随访过程中死亡,其中7例(10.1%)患者因前列腺癌进展死亡。本组患者3年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为59.7%、94.9%和89.8%,5年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为42.6%、91.5%和83.1%。Gleason评分8分与9~10分的高分级前列腺癌患者经粒子植入治疗后的无生化进展生存率Kaplan-Meier生存曲线比较差异有统计学意义(P0.05)。结论:应用I125放射性粒子植入术治疗高分级前列腺癌患者安全、有效,值得推广,但应注意Gleason评分≥9分患者,临床进展更为迅速,在临床工作中应予以重视。     

前列腺癌组织中蛋白表达与内分泌治疗后进展的相关性研究

目的 探讨前列腺癌内分泌治疗前癌组织中多种蛋白标记表达与内分泌治疗后发生进展的相关性,筛选内分泌治疗后进展的预测因子.方法 收集116例接受内分泌治疗的前列腺癌患者的临床病理资料,检测患者内分泌治疗前癌组织中雄激素受体(AR)、上皮型钙黏附索(E-cad-herin)、嗜铬粒蛋白A(CgA)、核增殖抗原(Ki67)、凋亡抑制蛋白(Survivin)、EZH2、hepsin蛋白表达,应用Cox比例风险模型进行多因素分析.结果 Ki67、EZH2、Survivin 3种蛋白表达与传统临床病理学因素存在Spearman等级相关.单因素分析中发现临床分期(P<0.001)、Gleason评分(P=0.005)、治疗前血清PSA值(P<0.001)以及Ki67(P=0.032)、Survivin蛋白(P=0.002)表达与内分泌治疗后的进展相关,多因素分析结果 显示临床分期(T_x N_+/M_+)(P<0.001)、高病理分级(Gleason评分≥8分)(P-0.038)和Survivin蛋白高表达(p＝0.031)是内分泌治疗后进展的重要危险因素.其中T_x N_+/M_+者67例(57.8%),Gleason评分≥8分者56例(48.3%),Survivin蛋白高表达者91例(78.4%). 结论 临床分期、病理分级、Survivin蛋白表达对于预测前列腺癌内分泌治疗后进展有重要意义.     

初诊前列腺癌~(11)C-胆碱PET/CT显像的临床价值初探

目的应用~(11)C-胆碱PET/CT技术对前列腺癌进行显像,以同层臀大肌SUVmax值为背景取其比值SUVmax—P/M值作为描述前列腺癌病灶胆碱摄取的指标,分析其与患者肿瘤病理分级及分期情况的相关性,以期对~(11)C-胆碱核素显像技术在前列腺癌的诊治中的应用价值进行初步探讨。方法共计39例前列腺癌患者纳入本项研究,均经组织活检术证实为前列腺癌。平均年龄67.3岁,其中Ⅱ期患者15例,Ⅲ期患者8例,Ⅳ期患者16例。将~(11)C-胆碱PET/CT结果,包括前列腺病灶SUVmax以及SUVmax—P/M值,与患者临床病理资料结果的关系进行统计学分析。结果前列腺癌病灶SUVmax值平均为9.41±7.20(1.66~24.65),SUVmax—P/M值平均为4.37±1.51(1.16~7.48)。如以SUVmax—P/M值2.3为诊断前列腺癌的界值,其诊断敏感度为87.2%(34/39)。Ⅱ期与Ⅲ期患者间SUVmax值与SUVmax—P/M值均无显著的统计学差(SUVmax,P=0.203;SUVmax—P/M,P=0.360),但两者在Ⅳ期患者中均显著升高(SUVmax,P=0.041;SUVmax—P/M,P=0.012)。SUVmax值与SUVmax—P/M值与Gleason积分相关系数分别为0.144和0.287,均无明显相关性。但是在Gleason积分7(4+3)分及以上的患者组的SUVmax—P/M值为显著地高于Gleason积分7(3+4)分及以下的患者组(P=0.021),而两组的SUVmax值无明显差异(P=0.193)。结论以同层肌肉SUVmax值校正后的前列腺癌病灶胆碱摄取值SUVmax—P/M值与前列腺癌分期、G1eason积分均有一定的相关性,能较好反映前列腺癌的肿瘤生物学行为,具有很高的临床应用价值。     

前列腺癌中垂体肿瘤转化基因表达及内分泌治疗后前列腺癌无进展生存期预测因素的研究

z=2.71,P=0.01,95%CI为1.20～3.16)和治疗前PSA≥20.0 ng/ml(HR=2.20±0.85,z=2.03,P=0.04,95%CI为1.03～4.70)是前列腺癌MAB治疗后肿瘤无进展生存期的影响因素.多重逐步回归分析显示只有PTTG表达情况(P=0.01)和病理分级(P=0.03)被选入最终模型. 结论 PTTG可能在前列腺癌发生发展过程中起重要作用.PTTG高表达、Gleason高分级是无远处转移前列腺癌患者接受MAB后肿瘤无进展生存期较短的独立预测因素.     

T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效观察及预后因素分析

目的 探讨T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效及预后影响因素.方法 2003年1月至2008年12月北京协和医院泌尿外科诊治T3a期前列腺癌患者38例,年龄48 ～ 84岁,平均71岁;前列腺特异性抗原(PSA) 10.000 ～99.800 μg/L,平均56.300 μg/L;Gleason评分5～9分,平均7.6分;穿刺活检针数阳性率10.0％～ 100％,平均65.3％.治疗方案为前列腺癌近距离治疗联合外放疗和内分泌治疗,观察患者联合治疗的效果,并运用Kaplan-Meier法绘制生存曲线.以患者术前年龄、前列腺体积、血清PSA值、Gleason评分和穿刺活检针数阳性率为变量,分别对生化复发、远处转移和总体生存状态行单因素分析.结果 38例患者随访9～ 109个月,平均69个月.19例出现生化复发,发生时间在术后1～ 40个月,平均13.4个月.13例出现远处转移,发生时间在术后1 ～ 70个月,平均19.7个月;15例死亡,9例死因为前列腺癌复发,6例为其他死因,平均死亡时间为术后52.2个月(9.0～98.5个月).总体的5年无生化复发率、无远处转移率、肿瘤特异生存率及总体生存率分别为44.1％、68.6％、82.4％及75.8％.29例患者出现1～2级泌尿系统不良反应,18例患者出现1～2级胃肠道不良反应.在单因素分析中,穿刺活检针数阳性率对生化复发(x2=17.240,P=0.000)、远处转移(x2=18.641,P=0.000)及总体生存状态(x2=8.970,P =0.003)有显著影响;Gleason评分对远处转移(x2=12.484,P=0.000)和总体生存状态(x2=6.575,P=0.010)有显著影响;年龄对总体生存状态(x2=5.179,P=0.023)有显著影响.结论 近距离治疗联合外放疗和内分泌治疗是T3a期前列腺癌的可选择方案,穿刺活检针数阳性率是影响患者生化复发、远处转移及总体生存率的因素.     

高危前列腺癌患者外放射治疗后生化复发危险因素分析

目的:探讨高危前列腺癌外放疗后影响生化复发的相关因素。方法:回顾性分析34例接受了外放射治疗的高危前列腺癌患者资料,术前均未接受内分泌或其他治疗。年龄51～87岁,平均(72.79±7.32)岁;初始前列腺特异性抗原(PSA)0.469～1 000μg/L,30.0μg/L者23例,≥30.0μg/L者11例;临床分期T_(1c)～T_4期;前列腺体积20.08～82.79 mL,平均(37.37±17.92) mL;放射剂量为1 800～7 000 cGy,平均(4 599.41±1 095.68) cGy;术后最低PSA为0～1 000μg/L,平均(70.11±214.63)μg/L;前列腺特异性抗原密度(PSAD)为0.02～46.82 ng/mL~2,平均(3.74±8.17) ng/mL~2;1例联合使用粒子植入治疗,34例均联合内分泌治疗。观察分析无生化复发率与初始PSA值、Gleason评分、临床分期、前列腺体积、外放射剂量、术后最低PSA及PSAD的关系。结果:本组所有患者均为高危前列腺癌患者,随访时间2～38个月,中位时间18个月,平均16.66个月。10例出现生化复发。3年无生化复发率为45.2%。PSA30μg/L组的无生化复发率高于PSA≥30μg/L组(P=0.020);放疗后最低PSA2μg/L者无生化复发率优于最低PSA≥2μg/L者,组间比较差异有统计学意义(P=0.000);Gleason评分≤7分者无生化复发率优于7分者,组间比较差异有统计学意义(P=0.046)。结论:初始PSA、Gleason评分、术后最低PSA与生化复发密切相关;前列腺体积、T分期、PSAD表现了与生化复发相关的趋势。     

代谢综合征与前列腺癌根治术后病理特征的相关性研究

目的 探讨行前列腺癌根治术的患者中代谢综合征与前列腺癌分期、分级的关系。方法 回顾性收集2009年1月至2016年7月于华西医院行前列腺癌根治术患者的临床资料，分为代谢综合征组与非代谢综合征组，比较两组临床资料特点，探究代谢综合征与前列腺癌分期、分级的关系。结果 纳入的499例前列腺癌根治术患者中，93例（18.6%）符合代谢综合征诊断标准。代谢综合征组肿瘤前列腺外浸润（pT3～4）的风险是非代谢综合组的2.2倍(OR =2.222, 95% CI:1.349～3.661, P=0.0002)，Gleason评分≥8分风险达到3倍（OR=3.061, 95% CI:1.313～7.137, P=0.010)。合并肥胖的前列腺患者肿瘤前列腺外浸润和Gleason评分≥8分风险分别是非肥胖患者的2倍(OR =2.000, 95% CI:1.279～3.128,P=0.002)和2.4倍(OR=2.436, 95% CI:1.068～5.555, P=0.034）。合并代谢综合征组分数量达到3个以上时，肿瘤前列腺外浸润的风险增加94%(OR=1.941, 95% CI:1.093～3.449, P=0.024)，Gleason评分≥8分的风险是无代谢综合组分患者的4.3倍(OR=4.316, 95% CI:1.530～12.174, P=0.006)。结论 代谢综合征与肿瘤前列腺外浸润和Gleason评分≥8分显著相关。肥胖与前列腺癌分期、分级正相关，只有当代谢综合征组分累积到代谢综合征状态时才导致高危前列腺癌的风险增加。     

Terapia de radiación corporal estereotáctica en pacientes con cáncer de próstata oligorrecurrente metacrónico. Experiencia de un centro

Introduction and objectiveMetachronous oligorecurrence in prostate cancer (PCa) occurs in patients with localized disease who, after failed radical treatment, develop oligometastases. Metastasis-directed stereotactic radiotherapy (SBRT) aims to delay androgen deprivation therapy. In this study, we report our experience to elucidate the role of SBRT in a selected population of patients with metachronous oligorecurrence.Material and methodsRetrospective analysis of patients treated with SBRT for oligorecurrent PCa between November 2015 and December 2020. We detailed clinicopathological characteristics at disease onset (age, PSA, stage, primary treatment), clinical scenario at diagnosis of oligorecurrence (PSA, PSA velocity, metastases characteristics), progression-free survival, castration resistance-free survival, dose, and toxicity of SBRT.ResultsThirty-eight SBRT treatments were applied to 13 lymph node and 25 bone metastases in a total of 28 patients. After a follow-up of 34.57 months (21.17-57.59), 17 patients had radiological progression of the disease and 11 presented castration resistant PCa. PFS and CRFS were 21.93 and 44.13 months, respectively. Only 2 patients presented grade 1 toxicity.ConclusionsIn patients with metachronous oligorecurrent PCa, SBRT constitutes a safe and effective treatment that allows delaying the onset of androgen deprivation therapy and the time to castration resistance, assuming low levels of toxicity.     

雄激素全阻断治疗对前列腺体积的影响及相关因素分析

目的 探讨前列腺癌近距离治疗前雄激素全阻断治疗对前列腺体积变化的影响及与临床病理因素的相关性。方法 前列腺癌患者74例。年龄54～84岁，平均71岁。均经会阴前列腺穿刺活检证实。血清PSA值2．8～71．2ng／ml；TNM分期T1cN0M0～T3aN0M0；Gleason评分5～9分65例，不确定9例；前列腺体积14～83ml，其中〈50ml42例，〉50ml32例。前列腺体积经三维治疗计划系统测量。采用手术去势加雄激素阻断（比卡鲁胺50ms／a或氟他胺250mg3次／d）31例，药物去势（戈舍瑞林3．6mg或亮丙瑞林3．75mg次／28d）加雄激素阻断治疗43例，时间2．1～5．6个月，平均2．8个月。观察前列腺体积变化与治疗前患者血清PSA值、Gleason评分、TNM分期、活检阳性区数及治疗方式的关系。结果 雄激素全阻断治疗后74例患者平均前列腺体积缩小37％。前列腺体积〉50ml者前列腺缩小程度大于体积〈50ml者（P=0．004）。前列腺体积缩小比率与治疗前体积大小呈正相关（r=0．321，P=0．006），而与治疗前血清PSA值、Gleason评分、TNM分期、活检阳性区数及雄激素全阻断治疗方式无关。结论 雄激素全阻断治疗可以缩小前列腺体积，使之适合粒子植入，治疗前前列腺体积越大，体积缩小越明显。     

Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation

Background : The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer.
Methods: Stage A₂, B or C prostate cancers were randomized to one of two groups: (i) group I ( n = 90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) group II ( n = 86), who underwent the surgery followed by 3 month androgen deprivation and subsequent adjuvant endocrine therapy. The effects of preoperative androgen deprivation on clinical relapse (serum prostate specific antigen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA relapse (PSA > 0.2 ng/mL) were evaluated at 2 years after randomization.
Results: There was no significant difference in clinical or PSA relapse-free survival and quality of life measures between the two groups, although relapses occurred significantly more frequently in patients who had more advanced stages, higher pretreatment PSA values or lower histologic differentiation in either group. Subgroup analysis indicated that clinical relapse-free survival in stage C cancer tended to be better in patients with preoperative androgen deprivation than in those patients without it ( P < 0.1).
Conclusions : Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant endocrine therapy over the 2 year observation period. A longer follow up is needed to clarify the exact extent of benefit in terms of survival and quality of life.     

Treatment of patients with high risk localized prostate cancer: results from cancer of the prostate strategic urological research endeavor (CaPSURE)

PURPOSE: Pretreatment risk assessment models facilitate more appropriate selection of treatment for prostate cancer. However, men with high risk disease remain a challenge with significant potential for primary treatment failure. We characterize patterns of treatment for high risk prostate cancer in a community based cohort. MATERIALS AND METHODS: In the Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) database, a longitudinal disease registry of men with prostate cancer, we identified those with nonmetastatic, high risk disease based on T stage, tumor grade and serum prostate specific antigen (PSA). Differences in primary treatment, and the use of neoadjuvant and adjuvant therapy in patients at low, intermediate and high risk were assessed. In the high risk cohort predictors of the type of primary treatment, and the use of neoadjuvant and adjuvant androgen therapy were identified. RESULTS: Of the cancers 34%, 40% and 26% were low, intermediate and high risk, respectively. Differences in primary treatment type among the 3 risk groups were statistically significant (p <0.0001) with increasing external beam radiation therapy and androgen deprivation, and decreased surgery, brachytherapy and surveillance in men with high risk cancers. In this group older age, higher PSA and nonprivate insurance were associated with decreased use of radical prostatectomy. More than half of the men at high risk receiving radiation therapy also received androgen deprivation, which was significantly higher than in the low and intermediate risk groups (p <0.0001). Factors associated with androgen deprivation in high risk disease were primary therapy, PSA, Gleason sum, T stage, body mass index, insurance status and ethnicity. PSA and Gleason sum were the primary determinants of adjuvant radiation after prostatectomy. CONCLUSIONS: Men with high risk but nonmetastatic prostate cancer are more likely to receive radiation therapy as well as androgen deprivation with the latter as primary therapy or in conjunction with local treatment. These data stress the importance of pretreatment risk stratification, education regarding appropriate combinations of local and systemic therapies, and the consideration of novel clinical trials in patients at higher risk.     

Prediction of organ-confined disease by prostate-specific antigen nadir after neoadjuvant therapy.

BACKGROUND: It is not clear whether or not serum prostate-specific antigen (PSA) levels after androgen deprivation prior to radical prostatectomy (neoadjuvant therapy) have any value in the prediction of the final pathologic stage. METHODS: We conducted a study on 49 patients who underwent retropubic radical prostatectomy following neoadjuvant therapy for clinical stage T1c, T2, and T3a prostate cancer. We evaluated progression-free survival based on the PSA failure rate and the predictive value of the PSA nadir after neoadjuvant therapy and other clinical factors to determine the most important predictor of organ confinement. RESULTS: Of the 49 patients, 30 had organ-confined disease. Of 31 patients without adjuvant therapy after surgery, the PSA failure-free rates at 2 years were 81.6 and 34.3% in the subset of organ-confined disease and non-organ-confined disease, respectively (P= 0.0031). Of the 18 patients with adjuvant androgen deprivation therapy after surgery, the PSA failure-free rate at 2 years was 100% and 59.7% in patients with organ-confined disease and non-organ-confined disease, respectively. Baseline PSA (P=0.037), PSA nadir (P<0.0001) and PSA density (P=0.003) significantly correlated with organ confinement. Multivariate logistic regression analysis revealed that the PSA nadir was the only independent predictor of organ confinement (P = 0.044). CONCLUSIONS: There was a trend that the patients with non organ-confined disease had a higher probability of PSA failure than did the patients with organ-confined disease. The PSA nadir after neoadjuvant therapy was the strongest predictor of organ confinement. The predictive value of the serum PSA nadir should be validated in well-designed larger population-based studies.     

Efficacy of primary hormonal therapy for patients with localized and locally advanced prostate cancer: A retrospective multicenter study

AIM: A retrospective review of patients with localized and locally advanced prostate cancer was performed to evaluate the efficacy of primary hormonal therapy and predict long-term prognosis in these patients. METHODS: A total of 628 patients who were diagnosed with stage T1c to T3 prostate cancer were treated with primary hormonal therapy at participating institutions. The patients were classified based on pretreatment prostate-specific antigen (PSA) level, Gleason score, and time to nadir PSA level. Disease-specific and progression-free survival rates were investigated, and compared among the subgroups. RESULTS: The mean age of patients was 74.5 years, and median pretreatment PSA level was 14.0 ng/mL. A total of 399 patients (63.5%) were treated with combined androgen blockade (CAB), and 229 patients (36.5%) were treated with castration monotherapy. The disease-specific survival rate of all 628 patients was 89.1% at 8 years. The group that showed a good response to primary hormonal therapy (Group G, pretreatment PSA level < or =20 ng/mL, Gleason score < or =7, and time to nadir PSA < or =6 months) accounted for approximately one-third of the total number of T1c-T3 patients. Disease-specific and progression-free survival rates at 8 years in Group G were 98.9% and 82.0%, respectively. These rates increased to 100% and 87.3%, respectively, in patients receiving CAB treatment in Group G. CONCLUSIONS: The results indicate the usefulness of primary hormonal therapy, especially CAB treatment, for patients showing a good response to hormonal therapy in long-term control of localized and locally advanced prostate cancer.     

Intermittent androgen suppression in patients with prostate cancer

OBJECTIVES: To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS: From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen-deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re-instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS: After a mean (range) follow-up of 45.6 (12-196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5-year metastatic disease free survival of 91.3%. The overall 5-year biochemical recurrence-free survival was 68%. Using multivariate analysis, a Gleason score of >or= 8 (P = 0.021), first-phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION: IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of 相似文献   

Prostate specific antigen doubling time after radical prostatectomy: effect of neoadjuvant androgen deprivation therapy

PURPOSE: We determined the predictors of prostate specific antigen (PSA) doubling time in patients with relapse after radical prostatectomy as well as whether PSA doubling time is shorter in those treated versus not treated with neoadjuvant androgen deprivation therapy. MATERIALS AND METHODS: We calculated PSA doubling time in 204 patients with PSA relapse after radical prostatectomy who were or were not treated with neoadjuvant androgen deprivation therapy. Analysis of covariance was used to determine the effect of clinical and pathological parameters on PSA doubling time, and the proportion of variability explained by these parameters. RESULTS: Clinical stage, and combined clinical stage and margin status, clinical stage and androgen deprivation therapy status, androgen deprivation therapy status and time to PSA relapse, and androgen deprivation therapy status and pretreatment PSA were significant predictors of PSA doubling time. Any variable or combination of variables explained up to only 21% of PSA doubling time variability. When stratified by pretreatment PSA, clinical stage and biopsy grade, the difference in doubling times in patients treated with or without neoadjuvant androgen deprivation therapy was significant only for 4.1 to 10 ng./ml. PSA. In this group mean doubling time plus or minus standard deviation in patients receiving neoadjuvant androgen deprivation therapy and those treated only with radical prostatectomy was 7.6+/-1.0 and 15.4+/-2.6 months, respectively. CONCLUSIONS: Our study indicates that it is difficult to predict PSA doubling time in an individual. The small proportion of variability in PSA doubling time explained by the interaction of androgen deprivation therapy status and other variables indicates that these factors are not clinically significant.