分析前列腺特异抗原检测结果预测前列腺癌发病趋势

目的　回顾我院 4年来前列腺疾病患者血清前列腺特异抗原 (PSA)测定结果与前列腺癌的检出率 ,分析兰州地区前列腺癌的发病趋势。方法　收集了 165 8例前列腺疾病患者血清PSA结果 ,城镇职工792例 ,农民 866例。对其中 2 37例PSA水平 >10 μg·L- 1者行前列腺穿刺活检。结果　检出前列腺癌 35例 ,占总例数 2 .1% ,占活检病例 14 .7% ;前列腺癌组血清PSA水平高于非前列腺癌组 (P <0 .0 1) ;城镇职工前列腺癌发病率逐年升高。结论　PSA是筛查前列腺癌的重要方法 ,兰州地区前列腺癌发病率逐年上升趋势 ,城镇职工发病率升高显著。     

雌激素治疗激素难治性前列腺癌的疗效观察

目的 观察雌激素治疗激素难治性前列腺痛(HRPC)的临床效果及不良反应.方法 收集北京大学泌尿外科研究所32例激素难治性前列腺癌患者资料,治疗经过每天口服己烯雌酚2 mg,观察服药后血清前列腺特异抗原(PSA)变化,疾病进展时间,患者总体生存率、疾病特异生存率并观察药物毒副作用.结果 29例前列腺癌患者资料完整,平均用药时间(8.6±0.9)个月,PSA反应(PSA降低＞50%)8例(27.5%),PSA稳定(PSA降低＜50%,或PSA增高＜25%)7例(24.1%);PSA进展(PSA增高＞25%)14例(48.3%).总体中位疾病进展时间4个月(1～12个月).PSA反应患者中位疾病进展时间6个月(5～12个月).总体生存率为48.3%,疾病特异生存率为55.2%.主要不良反应为乳房胀痛硬结10例(34.5%);深静脉血栓3例(10.3%).结论 每天口服2 mg己烯雌酚治疗激素难治性前列腺癌可使27.5%的患者PSA降低＞50%,24.1%患者PSA稳定,中位疾病进展时间4个月,雌激素治疗激素难治性前列腺癌效果肯定.

Abstract：

Objective To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer.Methods A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol (DES) 2 mg daily at our institute.The data of PSA (prostate-specific antigen)change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed.Results The data of 29 patients were complete.The mean duration of DES dosing was 8.6 ±0.9 months.Among them, 8 (27.5% ) patients achieved a PSA response with a 50% decrement of PSA or more.Seven (24.1% ) patients had a stable level of PSA(50% ＜ PSA ＜ 125% ) while 14 of 29 (48.3% ) maintained a PSA progression with a 25% increment of PSA or more.The overall median time to progression was 4 ( 1 - 12) months.And the median time to progression was 6 (5 - 12) months in the PSA response group.The overall survival rate was 48.3% and disease-specific survival rate 55.2%.The main adverse events were gynecomastia ( 10/29, 34.5% ) and deep vein thrombosis ( 3/29, 10.3% ).Conclusion When used for the treatment of hormone refractory prostate cancer, dethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27.5% patients and a PSA stability in 24.1% patients.And the median time to progression is 4 months.Estrogen is efficacious for the patients with hormone refractory prostate cancer.     

Should patients with a pre-operative prostatespecific antigen greater than 15ng/ml be offered radical prostatectomy?

Background Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) τ;15ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery. Aim To assess the outcome of patients who underwent RRP with a pre-operative PSA ≥ 15ng/ml. Methods Thirty-four patients, mean pre-operative PSA: 25.46ng/ml (15.03–76.6) and mean Gleason score: 6.4 (5–9) were assessed. Results Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30–106). Mean PSA: 18.8ng/ml (15.03–25.84). Mean Gleason score: 6.1 (5–7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36–98). Mean PSA: 28.9ng/ml (15.28–76.6). Mean Gleason score: 6.7 (5–9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2). Conclusion RRP seems feasible in patients whose pre-operative PSA is between 15 and 25ng/ml with stage T1c, Gleason score ≤ 7 and negative lymph node frozen section.     

Unusual prostate carcinoma characterized by extensive metastasis, significantly increased serum level of prostatic-specific antigen,and neuroendocrine differentiation: a case report

Some rare variants of prostate carcinoma have been described in recent years. In this article we report a man with uncommon prostate carcinoma with the following three pathological characteristics: (a) extensive metastasis to bone and lymph nodes of the abdomen, pelvis, and supraclavicular area;     

前列腺癌患者血清前列腺特异抗原水平与Gleason评分相关性分析

目的 分析前列腺癌患者血清中前列腺特异性抗原(PSA)水平、游离前列腺特异抗原与总前列腺特异抗原的比值(f-PSA/t-PSA)与Gleason评分的相关性,探讨血清PSA水平在前列腺癌诊断和鉴别中的临床应用价值。 方法 回顾性分析2014年6月—2015年9月在绍兴市人民医院泌尿外科治疗的109例前列腺癌患者的临床资料,所有患者均在B超引导下经直肠前列腺活检确诊为前列腺癌,根据患者的临床资料统计有无家族遗传史,并依据癌症TNM分类标准统计患者的临床分期,统计不同分类患者血清PSA平均水平,评价患者血清PSA、f-PSA/t-PSA水平与前列腺病理组织的Gleason评分的相关性。 结果 有家族患病史患者的平均血清PSA水平为(323.59±267.15)ng/ml,远高于没有家族史的患者(198.11±100.22)ng/ml,P＜0.05;不同TNM临床分期患者的血清PSA水平差异较大,Ⅰ期患者的血清PSA水平最低,平均为(6.28±4.08)ng/ml,Ⅳ期最高,为(459.08±123.01)ng/ml;前列腺癌患者血清PSA水平与前列腺组织病理切片的Gleason评分呈正相关(r=0.367,P＜0.001)。低分化癌患者的平均血清f-PSA/t-PSA为0.145±0.017,中分化癌患者为0.225±0.021,高分化癌患者为0.345±0.104,前列腺癌病理组织的Gleason评分与血清f-PSA/t-PSA成负相关(r=-0.378,P=0.008)。 结论 血清前列腺素特异抗原与前列腺组织Gleason评分具有相关性,对前列腺癌的早期临床诊断和治疗有重要意义,应列入前列腺癌的筛查方案。      

PSA及PSA mRNA在前列腺癌诊断中的价值

目的 评价前列腺特异性抗原(PSA)及PSA mRNA对前列腺癌的诊断价值.方法 选取老年男性前列腺癌患者53例作为受试对象,同时选取前列腺增生患者30例作为对照组,采用ELISA法检测血清PSA水平,采用反转录聚合酶链反应检测其mRNA的表达.结果 前列腺增生患者总PSA小于10 ng/ml,而前列腺癌患者总PSA大于10 ng/ml.当PSA小于4 ng/ml和大于10ng/ml时,PSA和PSAmRNA对前列腺癌的诊断与金标准相比,无统计学意义(P＞0.05).当PSA在诊断灰区4-10 ng/ml之间时,PSA mRNA与金标准相比,无统计学意义,而PSA低于金标准(P＜0.05).结论 血清PSA及PSA mRNA的检测对前列腺癌的诊断具有极其重要的作用,检测PSA的同时进行PSA mRNA的检测,有助于前列腺癌的诊断,尤其对PSA在诊断灰区的前列腺癌患者.     

Biological determinants of cancer progression in men with prostate cancer

CONTEXT: The recent increase in ability to diagnose prostatic adenocarcinoma has created a dilemma for treatment decisions. OBJECTIVE: To determine whether prostate cancer progression is associated with a modified version of the Gleason grading system together with selected morphologic and clinical variables. DESIGN: Retrospective analysis of a cohort of patients with peripheral zone prostate cancers who underwent surgery between August 1983 and July 1992. SETTING: University hospital. PATIENTS: Radical prostatectomy specimens from 379 men treated only by surgical excision were prospectively studied for 8 morphologic variables using previously standardized techniques. Variables were percentage of each cancer occupied by Gleason grade 4/5 (% Gleason grade 4/5, the Stanford modified Gleason scale), cancer volume, vascular invasion, lymph node involvement, seminal vesicle invasion, capsular penetration, positive surgical margin, prostate weight, and preoperative prostate-specific antigen (PSA) level. MAIN OUTCOME MEASURE: Biochemical progression of prostate cancer as indicated by serum PSA level of 0.07 ng/mL and increasing. RESULTS: Cancer grade expressed as % Gleason grade 4/5 and cancer volume were highly predictive of disease progression. In a Cox proportional hazards model that included % Gleason grade 4/5, the traditional Gleason score was not an independent predictor of treatment failure. Positive lymph node findings and intraprostatic vascular invasion were the only other variables that remained significant at the .01 level. CONCLUSION: The % Gleason grade 4/5, cancer volume, positive lymph node findings, and intraprostatic vascular invasion were independently associated with prostate cancer progression, defined by an increasing PSA level. Techniques to accurately measure cancer volume and % Gleason grade 4/5 are needed to better predict which patient will experience cancer progression. The commonly accepted predictors of progression-capsular penetration and positive surgical margins-were not independently predictive of failure after radical prostatectomy.     

晚期前列腺癌药物去势中Gleason评分、血清PSA与疗效相关性研究

目的：探讨晚期前列腺癌（Pca）患者药物去势治疗过程中疗效与Gleason评分及血清前列腺特异性抗原（PSA）的相关性。方法：选择33例晚期Pca患者，给予黄体激素释放激素类似物（LHRH—A）＋抗雄激素药物进行药物去势治疗，根据Gleason评分分为2～5分组、6～7分组、8～10分组，对3组血清PSA变化进行分析。结呆：Gleason评分6～7分组的病人在治疗后3个月内血清PSA值下降最快，治疗后6个月时Gleason评分2～5分组病人血清PSA值恢复正常，而Gleason评分6～7分组与8～10分组病人血清PSA值则接近正常值范围。不同Gleason评分组间血清PSA水平差异有统计学意义（F=5．396，P〈O．05）。结论：（1）Gleason评分、血清PSA水平与晚期Pca患者行药物去势疗法疗效有密切关系。（2）血清PSA变化是监测Pca复发与评价疗效的可靠瘤标。     

Intracranial metastasis of prostate cancer: report of two cases

Metastases from prostate cancer to the brain are very unusual and are seldom reported in the clinical literature. We report 2 cases of advanced stage prostate cancer with intracranial metastasis. One patient developed intracranial metastasis 5 years after step-up treatment. He had hormone refractory prostate cancer with a high level of prostate specific antigen (PSA). Unfortunately, he died of sepsis 3 weeks after craniotomy. The other patient with various neurologic symptoms and a normal PSA level responded to hormone therapy well. He had an uneventful postoperative course and has survived for more than 21 months after surgery. We also reviewed the literature and suggest that aggressive treatment, including neurosurgery, could improve the survival of certain patients with advanced prostate cancer with intracranial metastasis.     

前列腺基底细胞癌3例

探讨前列腺基底细胞癌（basal cell carcinoma,BCC）临床病理特点并提高诊疗认识。通过报道3例BCC患者的临床病理特点及诊疗经过,结合文献复习,提高对BCC诊疗特点的认识。3例BCC患者年龄为57~83岁,其中1例因血尿就诊,2例因排尿困难就诊。3例患者均合并前列腺增生,其中2例患者前列腺特异性抗原（prostate specific antigen,PSA）增高,1例PSA正常。病例1前列腺癌侵及膀胱、直肠前筋膜,伴淋巴结转移、骨转移、双肺多发转移,2014年11月2日行膀胱全切+双侧输尿管皮肤造口术+双侧闭孔及髂内淋巴结清扫术,术后病理诊断BCC,2015年1月8日复查盆腔增强MRI提示盆腔内复发,2015年7月11日复查腹部增强CT提示肝多发转移,胰腺转移,2015年10月因前列腺癌死亡。病例2于2015年3月27日行前列腺穿刺病理诊断为BCC,伴肺转移及骨转移,行化疗及内分泌治疗,后行局部放射治疗,2016年1月11日复查正电子发射断层显像与计算机断层显像（positron emission tomography and computed tomography,PET-CT）示患者肺转移瘤及骨转移瘤直径较前增大,数量增多,随访至2016年1月10日患者带瘤生存。病例3外院行经尿道前列腺电切术（transurethral resection of prostate,TURP）,术后病理考虑BCC可能,行PET-CT提示残余前列腺恶性肿瘤,伴双侧盆腔淋巴结转移可能,2016年4月20日复查PET-CT提示盆腔可见巨大不规则混杂密度影,临床考虑肿瘤复发,遂予局部放射治疗,随访至2016年1月10日患者带瘤生存。BCC临床罕见,是一种侵袭能力强、恶性程度较高、易发生转移的肿瘤,需要给予积极的治疗和密切的随访。     

免疫组化法和RT-PCR法检测胃癌淋巴结微转移

目的 :应用免疫组化方法和RT PCR方法检测常规病理检查淋巴结阴性胃癌之淋巴结微转移 ,比较两种检测方法的敏感性同时探讨检测胃癌淋巴结微转移的临床意义。方法 :采用CEA单克隆抗体免疫组织化学方法和CEAmRNART PCR方法分别检测 11例常规病理检查淋巴结阴性胃癌的 2 0 5枚淋巴结。结果 :CEA单克隆抗体免疫组织化学法检出 18枚 (8.8% )微转移淋巴结 ,而CEAmRNART PCR法共检出 46枚 (2 2 .4% )微转移淋巴结 ,两者比较差异显著 (P <0 .0 1)。 11例患者中有 6例存在淋巴结微转移 ,此 6例患者的重新TNM分期均有所上升。随访中发现有 2例微转移阳性患者分别于根治术后第 6、9个月出现复发。结论 :应用CEA单克隆抗体免疫组织化学方法或CEAmRNART PCR法可以检测出常规病理检查遗漏的胃癌淋巴结微转移灶。而且RT PCR法检测胃癌淋巴结微转移较免疫组织化学法更为敏感。检测常规病理检查淋巴结阴性胃癌的淋巴结微转移 ,有助于临床准确分期 ,判断预后及指导治疗。     

前列腺特异性抗原测定的临床意义

目的 :探讨放射免疫法测定血清PSA在前列腺疾病中的诊断价值。 方法 :应用放射免疫法测定 98例前列腺疾病患者的血清PSA值 ,并对比其对前列腺疾病的敏感性和特异性。 结果 :前列腺癌患者的血清PSA值明显高于正常者、良性前列腺增生和其它泌尿生殖系统疾病患者 ,PSA对前列腺癌诊断的敏感性为 92 %。 结论 :PSA对前列腺癌诊断的特异性不高 ,用于前列腺癌的筛选有其局限性。     

磁共振前列腺成像套餐对前列腺癌诊断的价值研究

目的观察磁共振前列腺成像套餐对前列腺癌诊断的应用价值,结合前列腺特异抗原(PSA)化验,比较磁共振成像与螺旋CT动态增强对前列腺癌诊断的准确性。方法收集我院病理确诊前列腺疾病患者20例,均行磁共振前列腺成像套餐及64排螺旋CT动态增强扫描。结果术后病理确诊前列腺癌16例,前列腺结节状增生4例。磁共振诊断前列腺癌18例,前列腺结节状增生2例;螺旋CT扫描动态增强均见前列腺明显肿大,其中强化不均仅7例,突破前列腺包膜3例,盆腔淋巴结肿大及骨转移各4例。结论相较CT动态增强扫描,磁共振成像对前列腺癌敏感性较高,但可能出现假阳性,DWI序列与波谱成像诊断价值更高。     

去势抵抗性前列腺癌进展时间的预测因素分析

目的：探索前列腺癌经内分泌治疗后进入去势抵抗性前列腺癌（castration-resistant prostate cancer, CRPC）的预测因素,以更好地指导临床和提高患者预后。方法：回顾性分析了2003年1月至2014年12月在北京大学第一医院泌尿外科确诊前列腺癌并且初始治疗为内分泌治疗的患者共185例,收集并整理分析的临床信息包括患者年龄、前列腺癌TNM分期、前列腺癌病理Gleason评分（Gleason score, GS)、前列腺癌危险度、内分泌治疗开始时前列腺特异性抗原（prostate-specific antigen, PSA）水平、经过内分泌治疗后的PSA最低值、PSA下降速率以及降到PSA最低值的时间。应用Kaplan-Meier生存分析和log-rank检验比较不同分组间CRPC进展时间的差异,应用Cox风险比例回归模型来分析评估这些因素对CRPC进展时间的影响。结果：185例患者平均年龄(71.02±8.67)岁,CRPC进展的中位时间为38个月（4~158个月）。单因素分析中,前列腺癌T分期、N分期、前列腺癌危险度、内分泌治疗前是否发生远处转移、PSA下降速率和PSA最低值均与CRPC进展时间显著相关（P值均小于0.01）。在多因素分析中,内分泌治疗前已发生远处转移（HR=6.030,95% CI：3.229~11.263,P=0.001）、较高的PSA最低值（HR=1.185,95% CI：1.080~1.301,P=0.001）、PSA下降速率>11 μg/(L·month)（HR=2.124,95% CI：1.195~3.750,P=0.001）以及到达PSA最低值的时间≤9个月（HR=3.623,95% CI：1.640~4.817,P=0.004）均是CRPC进展时间较短的危险因素。结论：前列腺癌患者经过内分泌治疗后,PSA下降速率越快,进入CRPC时间越短。     

前列腺增生症患者血清前列腺特异性抗原水平与前列腺炎关系的临床研究

目的探讨前列腺增生症患者血清中前列腺特异性抗原水平与前列腺炎的关系。方法120例门诊诊断为前列腺增生症的患者,其血清前列腺特异性抗原高于4.0ng/ml且合并前列腺炎;所有患者口服莫西沙星,治疗随访4周;根据治疗后血清前列腺特异性抗原水平及前列腺穿刺活检结果分为三组,观察比较各组治疗前后血清前列腺特异性抗原的水平及前列腺癌诊断阳性率。结果仅治疗后血清前列腺特异性抗原低于4.0ng/ml的一组在治疗前后的水平变化有统计学意义,其余两组均无统计学意义;治疗后前列腺癌诊断阳性率明显高于治疗前。结论对血清前列腺特异性抗原高于4.0ng/ml且合并前列腺炎的前列腺增生患者进行抗炎治疗,既可提高前列腺特异性抗原对前列癌早期诊断的特异性,又可使部分患者避免前列腺穿刺活检造成的痛苦和相关并发症。     

甲状腺乳头状癌合并乳腺癌患者的临床病理特征分析

目的: 分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并乳腺癌患者的临床病理特征，探讨两癌之间可能存在的联系。方法: 选择2016年12月至2021年12月郑州大学第一附属医院甲状腺外科收治的99例PTC合并乳腺癌患者(合并癌组)，另选择同期收治的99例未发现乳房结节的PTC患者(单纯癌组)，比较两组患者一般特征、PTC病理特征、甲状腺激素及抗原抗体水平。根据确诊顺序及间隔时间将PTC合并乳腺癌患者分为乳甲组(乳腺癌后确诊PTC)、甲乳组(PTC后确诊乳腺癌)、同时组(两癌确诊间隔时间不超过6个月)，比较3组患者确诊PTC及乳腺癌年龄、两癌确诊间隔时间、PTC淋巴结转移情况及乳腺癌病理特征。结果: 与单纯癌组相比，合并癌组肿瘤最大径更小，更倾向于微小癌，不易侵犯被膜及周围组织，确诊PTC时年龄明显增高，多处于绝经状态，且血清游离四碘甲状腺原氨酸(serum free tetraiodothyronine,FT4)水平明显降低，甲状腺球蛋白(thyroglobulin,Tg)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)表达水平明显升高(P均<0.05)。与甲乳组相比，乳甲组两癌确诊间隔时间明显缩短(P<0.05)；与同时组相比，乳甲组颈侧区淋巴结转移率明显增高(P<0.05)。结论: PTC合并乳腺癌患者甲状腺肿瘤最大径更小，部分患者发展迅速且易出现跳跃性转移；Tg、TPOAb和TRAb高表达的PTC患者乳腺癌发病风险增高。     

血清前列腺特异性抗原水平正常的前列腺癌6例及文献复习

目的:探讨在血清前列腺特异抗原(PSA)水平正常时,如何避免前列腺癌的漏诊。方法:对203例血清PSA水平正常的前列腺增生患者在经尿道前列腺电切术后,病理检查中发现的6例前列腺癌患者临床资料进行回顾分析。结果:6例前列腺癌患者普通超声检查和肛门指诊未发现前列腺癌的征象,均为初次就诊入院,6例患者中病理检查有1例差(未)分化和1例中分化前列腺癌,病情发展迅速,短期内死亡。其余4例病理检查为高分化前列腺癌的患者目前仍存活。结论:早期偶发前列腺癌和进展型前列腺癌可能出现血清PSA正常,有发生漏诊的可能。应综合超声、磁共振,特别是经直肠前列腺超声检查和前列腺特异抗原速率来考虑,对疑似患前列腺癌的患者进行前列腺穿刺病检,以提高前列腺癌的早期诊断率。     

前列腺偶发癌的诊断和治疗

目的:探讨前列腺偶发癌的诊断和治疗.方法:回顾性分析1999～2005年因良性前列腺增生进行TURP或前列腺切除术325例资料,前列腺偶发癌在本文中定义为术前患者经直肠指检和PSA检查均为阴性,而术后病理发现前列腺癌.结果:325例前列腺增生患者中发现前列腺偶发癌12例,其中T1a期10例,T1b期2例.结论:T1a期前列腺偶发癌患者可以观察等待,而T1b期前列腺偶发癌需要积极治疗和密切随访.     

7例膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的讨论膀胱移行细胞癌伴前列腺癌的诊断和治疗。方法对389例膀胱移行细胞癌患者中伴有前列腺癌的7例患者资料进行分析。结果 7例患者均经活组织检查和膀胱镜检查诊断为膀胱移行细胞癌,经前列腺穿刺活检,被诊断为前列腺腺癌。3例患者经尿道采用电切术将膀胱肿瘤及双侧睾丸切除,术后用丝裂霉素或者BCG对患者膀胱实施药物灌注,同时口服氟他胺治疗前列腺癌。1例患者的部分膀胱及双侧膀胱被实施切除,并在术后对患者的前列腺癌实施体外辅助放射治疗。3例实施膀胱前列腺全切术加回肠膀胱术。7例患者中,失访2例,随访5例,其中2例发生多发转移导致术后生存时间不到1年,另外3例在术后随访1.5～4.0年,恢复良好,未发现肿瘤复发或者转移。结论前列腺穿刺活检、TRUS、DRE、血清PSA测定、活组织检查和膀胱镜检综合检查是目前诊断前列腺癌伴膀胱移行细胞癌的主要方法。膀胱前列腺根治性切除是取得较好治疗效果的重要因素。     

The Antiandrogen Withdrawal Syndrome

Objective To evaluate the response to antiandrogen withdrawal in patients with advanced prostate cancer treated with combined androgen blockade.Methods Twenty-four cases of advanced prostate cancer (10in stage C and 14 in stage D) were retrospectively studied.All the patients were treated with combined androgen blockade(bilateral orchiectomy and flutamide).After initial response to hormone therapy for 7 to 36 months,flutamide was discontinued because of deterioration of the disease.Serum prostate specific antigen(PSA) levels were checked every 2 to 4 weeks and symptoms observed.Results The results following withdrawal of flutamide were as follows:8 patients showed a decling in PSA(mean 74.8%),of whom 6 cases had the PSA decling greater than 50%.Clinical symptoms improved in 4 cases.The nodules of the prostate were smaller than before in cases.The mean duration of response was 4.3 months.Conclusion In patients with hormone refractory advanced prostate cancer after initial combined androgen blockade therapy,a trial of “antiandrogen withdrawal”is a reasonable choice of therapeutic maneuver.