晚期前列腺癌的雄激素阻断治疗

目的探讨间歇性雄激素阻断治疗与持续性雄激素阻断治疗晚期前列腺癌的疗效和不良反应。方法65例晚期前列腺癌患者分为两组，A组34例行间歇性雄激素阻断（IAB）治疗，B组31例行持续性雄激素阻断（CAB）治疗，比较两组在疾病进展时间和不良反应方面的差异。结果A组中位随访时间为37．0个月，B组中位随访时间为35．8个月。A、B组疾病进展率分别为29．4％和54．8％，两组比较差异有统计学意义（P=0．038）。A、B组疾病中位进展时间分别为34．9个月、28．4个月，两组比较差异有统计学意义（P=0．0018）。在有骨转移患者中，A、B组疾病中位进展时间分别为33．6个月、27．1个月，两组比较差异有统计学意义（P=0．020）。在无骨转移患者中，A、B组疾病中位进展时间分别为38．7个月、30．3个月，两组比较差异有统计学意义（P=0．0006）。不良反应发生率分别为A组发生潮热症状23．5％、乳腺肿痛17．6％、骨质疏松14．7％。B组发生潮热症状64．5％、乳腺肿痛54．8％、骨质疏松45．2％。两组比较差异有统计学意义：潮热症状P=0．0006，乳腺肿痛P=0．0014，骨质疏松P=0．0065。结论对晚期前列腺癌患者IAB治疗可以延缓病变的进展，减少雄激素阻断导致的不良反应，提高患者的生活质量，应作为晚期前列腺癌患者的首选治疗。     

非那雄胺在晚期前列腺癌治疗中的作用

目的：探讨非那雄胺加间歇性雄激素阻断在晚期前列腺癌治疗中的作用。方法：将33例T3。期或T4期前列腺癌患者分为两组,A组18例采用比卡鲁胺加戈舍瑞林,间歇性雄激素阻断治疗;B组15例采用非那雄胺加比卡鲁胺加戈舍瑞林治疗。间歇期内B组继续服用非那雄胺。结果：治疗后9个月,A组13例完全缓解．3例部分缓解,2例无变化,有效率为88．9％。前列腺特异性抗原（PSA）为0．3～37．3ng／ml,平均（7．6±6．5）ng／ml。B组12例完全缓解,2例部分缓解,1例无变化,有效率为93．3％。PSA为0．1～10．5ng／ml,平均（4．2±2．8）ng／ml。B组PSA值低于A组,差异有统计学意义（P〈0．05）。随访61．7（31～82）个月,B组停药间期（25．1±10．1）个月长于A组（15．7±8．6）个月（P〈0．05）。A组5年生存率为55．6％（10／18）,B组为66．7％（10／15）,差异无统计学意义（P〉0．05）。治疗后5年,A组仍有6例有效（33．3％）,B组8例有效（53．3％）,差异无统计学意义（P〉0．05）。结论：非那雄胺加上间歇性雄激素阻断治疗,能使晚期前列腺癌PSA进一步降低,停药间期延长。     

间歇性雄激素阻断治疗晚期前列腺癌效果观察

目的 评价间歇性雄激素阻断治疗晚期前列腺癌的可行性及优点.方法 选取晚期前列腺癌患者59例,随机分为2组.给予间歇性雄激素阻断治疗30例(A组),给予持续雄激素阻断治疗29例(B组),观察两组患者的疾病进展及治疗期间副反应的发生情况,比较两种方法的治疗效果.结果 A组患者平均随访26个月,B组患者平均随访27个月,两组患者疾病进展情况未见明显差异.A组患者副反应低于B组患者且能在治疗间歇期得到缓解.结论 间歇性雄激素阻断治疗方法可行,能够减少患者治疗的副反应,提高患者生活质量.     

间歇性与持续性雄激素阻断治疗晚期前列腺癌疗效比较

目的：比较间歇性与持续性雄激素阻断治疗晚期前列腺癌的疗效以及治疗产生的副作用。方法选取我科2012年1月-2013年1月收治的晚期前列腺癌患者76例,分为观察组（38例）及对照组（38例）。观察组38例行间歇性雄激素阻断治疗即药物去势加抗雄激素药物,对照组38例行持续性雄激素阻断治疗即手术去势加抗雄激素药物。比较两组患者的副反应发生率及治疗后的生活质量。结果观察组38例患者发生潮热症状者13例（34.21％）、乳房胀痛者12例（31.58％）。对照组23例患者发生潮热症状者26例（68.42％）、乳房胀痛者25例（65.79％）。比较两组潮热症状及乳房胀痛的发生率差异均有统计学意义（P＜0.05）。两组患者治疗后,观察组患者在肠道症状、性功能、尿路症状、骨痛、治疗相关症状方面都较对照组有明显的改善,生活质量大大提高,两组对比差异有统计学意义（P＜0.01）。结论间歇性联合雄激素阻断治疗可以明显降低患者治疗的副作用并且增加治疗后的生活质量,是晚期前列腺癌患者行雄激素阻断治疗的首选方案。     

全雄激素阻断和全雄激素阻断结合^125I放射微粒植入治疗前列腺癌

目的：探讨全雄激素阻断和全雄激素阻断结合^125I放射微粒植入治疗前列腺癌的临床疗效。方法：收集我院近10年来中晚期前列腺癌病人44例，其中C期28例，D期16例。双侧睾丸切除 抗雄激素药物治疗(A组)35例，双侧睾丸切除 抗雄激素药物 ^125I放射微粒植入近距离放射治疗(B组)9例。比较治疗前后PSA的变化及生存率。结果：A组35例病人PSA平均值由60．3μg／L降至12．1μg／L。B组9例病人PSA平均值由72．1μg／L降至3．6μg／L。35例A组病人随访9～84(平均39．2)个月，排除非癌性死亡3例，因前列腺癌引起的死亡6例，生存率为81．3％(26／32)。B组9例病人随访7～24(平均13)个月，病人全部存活。结论：全雄激素阻断治疗及伞雄激素阻断治疗结合^125I放射微粒植入近距离放射治疗．是治疗中晚期前列腺癌的可供选择的有效方法。     

局部进展期前列腺癌内分泌治疗的临床研究

目的 探讨局部进展期前列腺癌内分泌治疗的治疗方法.方法 总结研究自2006年11月～2012年10月在本院泌尿外科诊断为局部进展期前列腺癌而行内分泌治疗的52例患者的病例资料,其中实验组（IAD组）27例采用间歇性雄激素阻断治疗,对照组（CAD组）25例均给予持续性雄激素阻断治疗,根据生活质量调查量表EORTC QLQ-PR25（见附录）记录生存质量数据,比较两组患者的临床症状缓解情况、前列腺癌进展时间、患者生活质量及副反应的发生情况.结果 IAD组患者平均随访（41.4±1.2）个月,CAD组患者平均随访（37.2±2.5）个月,IAD组患者的中位生存期35.6个月,CAD组患者的中位生存期为30.2个月,两组间无进展生存率差异具有显著性（P＜0.05）;在IAD组,患者的尿路症状、治疗相关症状及性功能情况比CAD组有较好的生活质量（P＜0.05）,而两组患者肠道症状无明显差异（P ＞0.05）;IAD组27例患者发生潮热症状者7例（25.9％）、乳房胀痛者4例（14.8％）;CAD组25例患者发生潮热症状者13例（52.0％）、乳房胀痛者11例（44.0％）,比较两组潮热症状及乳房胀痛发生率均有显著性差异（P＜0.5）.结论 间歇性雄激素阻断治疗较之持续性雄激素阻断治疗可减轻雄激素阻断造成的副作用,提高患者的生活质量,降低用药剂量及治疗费用,延缓进展至非激素依赖性前列腺癌的时间,是治疗局部进展期前列腺癌的有效的内分泌治疗方式.     

锤头型核酶特异性阻断雄激素受体表达对前列腺癌细胞生长的影响

目的：探讨核酶阻断雄激素受体（AR）基因表达治疗前列腺癌的可能性。方法：在脂质体介导下，锤头型抗雄激素受体核酶表达载体转染前列腺癌细胞，采用逆转录－聚合酶链反应（RT－PCR）检测ARmRNA，四甲基偶氮唑盐（MTT）法检测细胞增殖活性，流式细胞仪（FCM）检测细胞周期时相，原位末端转移酶标记法检测细胞凋亡。结果：核酶表达载体转染1－5d后，前列腺癌细胞AR mRNA水平降低32．6％－40．7％（P＜0．05），细胞生长抑制率18．28％－35．34％（P＜0．05），细胞周期阻滞于G2／M期，诱导细胞凋亡，细胞凋亡比率增加20．70％（P＜0．01）。结论：应用核酶特异性切割ARmRNA，能有效阻断AR基因的表达，诱导前列腺癌细胞凋亡，有可能成为前列腺癌基因治疗的有效方法之一。     

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。     

间断雄激素阻断治疗进展期前列腺癌之8年临床经验分析

目的:探讨间断雄激素阻断法(IAD)治疗进展期前列腺癌的安全性及用药周期特征。方法:178例进展期前列腺癌患者依据临床分期分为A(T3-4N0M0)、B(TXN1M0)和C(TXNXM1)3组。所有患者一经确诊即给予最大雄激素阻断治疗至少6个月,至PSA≤0.2μg/L后维持3个月后,暂停雄激素阻断治疗,进入间歇期(Off-Period);当PSA>4μg/L时,进入用药期(On-Period),直至PSA再次达到0.2μg/L以下停药。分别记录各组患者年龄、初始PSA值、Gleason评分以及治疗期间每个周期的用药期及停药期时间、PSA水平及肿瘤进展时间。结果:A、B、C 3组患者初始PSA水平分别为(27.5±14.6)、(43.4±21.8)、(62.8±44.6)μg/L(P<0.01);平均随访时间分别为(38.4±9.6)、(33.1±14.0)、(28.3±14.3)个月;开始治疗至出现肿瘤进展的平均时间为(37.4±6.6)、(27.4±10.2)、(16.6±4.4)个月。A组患者平均间歇期时间显著长于B组和C组,C组患者On/Off值显著大于A组,且完成的IAD周期数显著少于A组(P<0.01)。19例A组患者完成5个治疗周期。C组患者最多完成3个治疗周期即出现PSA及肿瘤进展。2例A组患者死于心血管事件;B组患者6例死亡,其中1例死于前列腺癌转移;C组36例死亡,其中21例死于转移性前列腺癌。结论:与存在远处转移的前列腺癌患者相比,局部进展性前列腺癌患者采用间断雄激素阻断治疗可有效缓解肿瘤进展,减少IAD治疗的相关不良反应,提高患者生活质量。     

全雄激素阻断和全雄激素阻断结合~(125)I放射微粒植入治疗前列腺癌

目的 :探讨全雄激素阻断和全雄激素阻断结合12 5I放射微粒植入治疗前列腺癌的临床疗效。　方法 :收集我院近 10年来中晚期前列腺癌病人 44例 ,其中C期 2 8例 ,D期 16例。双侧睾丸切除 +抗雄激素药物治疗 (A组 )35例 ,双侧睾丸切除 +抗雄激素药物 +12 5I放射微粒植入近距离放射治疗 (B组 ) 9例。比较治疗前后PSA的变化及生存率。　结果 :A组 35例病人PSA平均值由 6 0 .3μg/L降至12 .1μg/L。B组 9例病人PSA平均值由72 .1μg/L降至 3.6 μg/L。 35例A组病人随访 9～ 84(平均39.2 )个月 ,排除非癌性死亡 3例 ,因前列腺癌引起的死亡 6例 ,生存率为 81.3%(2 6 / 32 )。B组 9例病人随访 7～ 2 4(平均 13)个月 ,病人全部存活。　结论 :全雄激素阻断治疗及全雄激素阻断治疗结合12 5I放射微粒植入近距离放射治疗 ,是治疗中晚期前列腺癌的可供选择的有效方法。     

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.     

晚期前列腺癌联合雄激素阻断治疗的长期随访

目的:了解晚期前列腺癌联合雄激素阻断治疗的长期生存率。方法:选取1993年1月~2000年1月初采用联合雄激素阻断治疗的59例前列腺腺癌患者,其中28.81%和45.76%为临床局部晚期(T3-4 N0M0期)和转移(TxNxM+期)病例,全部随访5年以上。结果:全组病例3、5、7年的总体生存率分别是79.36%、61.46%、49.15%,其中,临床局部晚期和转移者的5年生存率分别为80.77%和32.65%,而高分化腺癌和低分化腺癌的5年生存率分别为86.21%和30%(P<0.01)。另外,PSA>30μg/L时其长期生存率有明显下降趋势。结论:采用内分泌治疗的晚期前列腺癌,病理低分化、临床分期达T3 c-4NxMx或TxNxM+期及PSA>30μg/L均提示预后较差,晚期前列腺癌病例的治疗应综合多因素,选择个体化方案。     

Prostate-specific antigen response to deferred combined androgen blockade therapy using bicalutamide predicts survival after subsequent oestrogen and docetaxel therapies in patients with castration-resistant prostate cancer

Study Type – Prognosis (retrospective cohort analysis) Level of Evidence 2b What's known on the subject? and What does the study add? The additional use of anti‐androgen (deferred combined androgen blockade [CAB] therapy) for patients with castration‐resistant prostate cancer (CRPC) initially treated with androgen deprivation monotherapy (ADMT) can provide a clinical response, although the reported response rates vary widely. Our previous study, which reported a response rate of 66% to deferred CAB therapy, suggested that deferred CAB responders would also respond better to subsequent therapies than non‐responders because the difference in cancer‐specific survival between the deferred CAB responders and the non‐responders was much larger than the progression‐free survival rates for the responders. The present study showed that PSA response to deferred CAB therapy predicts clinical outcomes after subsequent oestrogen and docetaxel therapy. We propose that PSA response to deferred CAB be used for planning individualized treatment that includes secondary hormonal therapy and chemotherapy.

OBJECTIVE

• ? To evaluate whether there is any association between prostate‐specific antigen (PSA) response to deferred combined androgen blockade (CAB) therapy using bicalutamide in patients with castration‐resistant prostate cancer (CRPC), initially treated with castration monotherapy, and the clinical outcomes after subsequent oestrogen and docetaxel therapies.

PATIENTS AND METHODS

• ? Fifty‐six patients with advanced prostate cancer, who were refractory to both initial castration monotherapy and subsequent deferred CAB, received oestrogen therapy (estramustine phosphate 140 or 280 mg/day in 50 patients, diethylstilbestrol diphosphate 100 mg/day orally in six patients). Of the 56 patients, 33 underwent docetaxel therapy (median dose 55 mg/m², every 4–8 weeks, median 6 courses) when they became refractory to oestrogen therapy.
• ? A deferred CAB response was defined as a decrease of >50% in PSA levels after the addition of bicalutamide. The difference in cancer‐specific survival (CSS) after confirmation of resistance to initial castration monotherapy between the deferred CAB responders and the non‐responders was evaluated, and outcomes after oestrogen and docetaxel therapies were also compared between the two groups.

RESULTS

• ? A response to deferred CAB was observed in 27 (48%) of the 56 patients. There was no significant difference between the responders and the non‐responders in pretreatment clinical variables, including Gleason score, metastatic sites, PSA level at diagnosis, and PSA nadir during castration monotherapy.
• ? A deferred CAB response was a significant predictor of CSS after confirmation of resistance to initial castration monotherapy.
• ? The deferred CAB responders had significantly longer progression‐free survival (PFS) (median 3.2 months in the responders, 2.1 month in the non‐responders, P= 0.04) and CSS (median 3.0 years in the responders, 1.5 years in the non‐responders, P= 0.04) after oestrogen therapy. Likewise, PFS (median 8.2 months in the responders, 2.2 months in the non‐responders, P < 0.01) and CSS (median not reached in the responders, 1.4 years in the non‐responders, P < 0.01) after docetaxel therapy was significantly longer in the deferred CAB responders.

CONCLUSION

• ? PSA response to deferred CAB predicts clinical outcomes after subsequent oestrogen and docetaxel therapies in patients with CRPC, and provides useful information for planning individualized optimum treatment courses that include secondary hormonal therapy and chemotherapy.

     

Deferred combined androgen blockade therapy using bicalutamide in patients with hormone-refractory prostate cancer during androgen deprivation monotherapy

OBJECTIVE: To assess the effect of adding bicalutamide on serum prostate-specific antigen (PSA) levels in patients with hormone-refractory prostate cancer (HRPC) during androgen deprivation monotherapy (ADMT). PATIENTS AND METHODS: Forty-four patients with HRPC were treated with deferred combined androgen blockade (CAB) therapy, administering bicalutamide 80 mg once daily. HRPC was defined biochemically as three consecutive rises in PSA level during ADMT. The treatment response was defined as a > or = 50% decline in PSA levels. Prognostic values of various pretreatment variables for responsiveness to deferred CAB were determined statistically. When the disease relapsed during deferred CAB, bicalutamide was discontinued and the patients were evaluated for the antiandrogen withdrawal syndrome (AWS). RESULTS: Of the 44 patients, 29 (66%) had a PSA response; the median PSA failure-free survival was 9.2+ months. Biopsy Gleason score was the only pretreatment variable predictive of a PSA response (mean Gleason score 7.9 in responders and 8.7 in nonresponders). The PSA doubling time (PSA-DT) was the only statistically significant variable of PSA failure-free survival in a multivariate analysis. The 1- and 2-year PSA failure-free survival rates were 43% and 31% in patients with a PSA-DT of >4 months, while it was 21% and none, respectively, in those with a PSA-DT of <4 months. Responders to deferred CAB had a statistically longer cancer-specific survival than nonresponders. None of 20 patients who were evaluated for AWS had the condition. CONCLUSIONS: Deferred CAB therapy using bicalutamide is effective in patients with progression during ADMT, particularly in those with lower Gleason score tumours or a longer PSA-DT. AWS after deferred CAB is uncommon.     

Effects of combined androgen blockade on bone metabolism and density in men with locally advanced prostate cancer

Objective: To investigate whether combined androgen blockade (CAB) produces any adverse effects on bone metabolism and mineral density in patients with locally advanced prostate cancer.Materials and methods: The study group consisted of 17 stage T4 prostate cancer patients treated with CAB and had no evidence of bone metastasis on bone scintigraphy. The mean duration of CAB and final total prostate specific antigen (PSA) level at the time of study were found at 28.5 ± 15.9 (6–58) months and 0.39 ± 0.5 (0.1–2) ngml, respectively. Twenty age and socioeconomically matched benign prostate hyperplasia (BPH) patients were taken as the control group. Both groups were compared with regard to lumbar bone mineral density (LBD), femur bone mineral density (FBD) and serum parameters of bone metabolism namely calcium (Ca), phosphate (P), magnesium (Mg) and alkaline phosphatase (ALP). Bone mineral density was measured with dual energy x-ray absorptiometry.Results: The mean FBD, LBD and serum Ca, P, Mg and ALP measurement of the patients treated with CAB were 0.85 ± 0.1 g/cm², 1.16 ± 0.2 g/cm², 9.1 ± 0.3 mg/dl, 3.6 ± 0.6 mg/dl, 1.95 ± 0.14 mg/dl, 187.5 ± 61 mg/dl, respectively. No significant difference was found between patients subjected to CAB and the age matched controls in any of the studied parameters namely age, FBD, LBD, Ca, Mg and ALP except serum phosphate. Serum phosphate levels were significantly (p =0.001) higher in patients treated with CAB suggesting a minor effect of CAB on bone metabolism.Conclusion: No convincing evidence was found about the detrimental effect of CAB on bone mineral density and metabolism in a highly selected group of patients with advanced prostate cancer without bone metastases.     

A prospective, open label, randomized phase II trial of weekly docetaxel versus weekly vinorelbine as first line chemotherapy in patients with androgen independent prostate cancer

PURPOSE: In previous phase I to III studies docetaxel and vinorelbine have shown promising activity in androgen independent prostate cancer. In the present trial we assessed the efficacy and tolerability of single agent low dose docetaxel vs vinorelbine in patients with advanced androgen independent prostate cancer. MATERIALS AND METHODS: A total of 40 chemotherapy naive patients with histologically proven androgen independent prostate cancer, adequate androgen ablation, and clinical and/or biochemical progression were randomly assigned to receive either 25 mg/m(2) docetaxel (arm A) or 25 mg/m(2) vinorelbine (arm B) weekly. Treatment was continued until clinical and/or biochemical progression. In cases of progression patients switched to the alternative treatment arm. The primary end point was time to disease progression. Secondary end points included prostate specific antigen response rates in sequential treatment, analgesic response and toxicity. RESULTS: The current analysis showed a doubled risk of progression in treatment arm B. The median time to first disease progression was 14.5 months for arm A vs 4.4 months for arm B. The proportion of patients with a greater than 50% prostate specific antigen decrease on first line therapy was significantly higher in arm A (62.5%) compared to arm B (11.1%) (p = 0.0033). After progression to docetaxel second line vinorelbine yielded a greater than 50% prostate specific antigen response rate of 28.6% vs 62.5% for second line docetaxel. Clinically significant toxicity occurred more often in arm B with neutropenia grade 4 seen in 22% and grade 3 in 28% of patients (p = 0.0005) during the first treatment phase. CONCLUSIONS: While weekly application of both cytotoxic agents was well tolerated, this study demonstrates the superiority of docetaxel vs vinorelbine as monotherapy in the treatment of androgen independent prostate cancer.     

Androgen and prostate cancer: the role of primary androgen deprivation therapy in localized prostate cancer

BackgroundThe basic mechanisms and clinical efficacy of primary androgen deprivation therapy (PADT), especially combined androgen blockade (CAB) for localized or locally advanced prostate cancer (PCa) have been outlined. An important point relates to which patients are suitable candidates for PADT.MethodsA retrospective review of the efficacy of PADT in 628 patients with localized or locally advanced PCa treated with PADT at seven institutions in Japan was carried out.ResultsIt was found that more than 30% of low- or intermediate-risk localized PCa patients could have their disease controlled over the long-term by PADT alone. Short-term or intermittent PADT could not be recommended because of the possibility of character change in the cancer cells as a result of incomplete androgen ablation.ConclusionAlgorithms are proposed for the treatment of localized PCa not only in low- and intermediate-risk groups, but also in the high-risk group. Future research directions are indicated.     

Therapeutic effects of the combined androgen blockade therapy versus luteinizing hormone-releasing hormone analog monotherapy in patients with hormone naïve metastatic prostate cancer: a multi-institutional comparative analysis

BackgroundThe clinical benefit of the combined androgen blockade (CAB) therapy over luteinizing hormone-releasing hormone analog (LH-RHa) monotherapy for hormone naïve metastatic prostate cancer (mHNPC) is unclear. Therefore, we retrospectively compare the effectiveness of CAB with the LH-RHa monotherapy on the prognosis of Japanese patients with mHNPC.MethodsWe retrospectively evaluated the prognosis of 517 patients diagnosed with mHNPC between August 2001 and May 2017. The patients’ data were obtained from the Michinoku Urological Cancer Research Group database and Hirosaki University-related hospitals. Patients were divided into the CAB and LH-RHa monotherapy groups based on primary androgen deprivation therapy (ADT). Overall survival (OS), cancer-specific survival (CSS), and castrate-resistant prostate cancer-free survival (CRPC-FS) were compared between the two groups using the Kaplan-Meier curve analysis. Inverse probability of treatment weighting (IPTW)-adjusted Cox hazard proportional analyses was performed to investigate the effect of primary ADT on oncological outcomes.ResultsThe median age was 73 years old. The numbers of patients in the CAB and LH-RHa monotherapy groups were 447 and 70, respectively. The Kaplan-Meier curve analysis showed no significant differences in either 5-year OS (56.7% vs. 52.5%, P=0.277), CSS (61.1% vs. 56.4%, P=0.400), and CRPC-FS (33.1% vs. 31.1%, P=0.529) between the groups. IPTW-adjusted multivariate Cox hazard proportional analyses showed no significant differences in OS, CSS, and CRPC-FS between the two groups.ConclusionsNo significant differences in oncological outcomes were observed between the CAB and LH-RHa monotherapy groups in patients with mHNPC.