磷酸雌二醇氮芥联合足叶乙甙治疗激素抵抗性前列腺癌

目的观察磷酸雌二醇氮芥(EMP)联合足叶乙甙(Vp16)治疗激素抵抗性前列腺癌的疗效.方法2000年1月至2004年6月对12例全雄激素阻断治疗失败、排除氟他胺撤药综合征的激素抵抗性前列腺癌患者行EMP加Vp16联合化疗.患者年龄61～82岁,平均70岁.病理分级G23例,G39例.其中骨转移10例,软组织转移4例(肺转移2例,淋巴结转移2例).化疗方案EMP 560 mg/d,Vp16 50 mg·m-2·d-1,连续口服21 d,28 d为1个周期.直至病情进展或毒副反应无法耐受.疗效判断标准血PSA下降＞50%且维持＞1个月为有效;软组织转移灶疗效分为完全缓解、部分缓解、稳定和进展.结果12例随访6～24个月,平均12个月.PSA有效率50%(6/12),有效患者PSA从治疗前(63.9±47.3)ng/ml下降至(14.4±8.8)ng/ml,平均有效时间7.5个月.软组织转移灶部分缓解者2例,转移灶分别从治疗前的4.0 cm×5.0 cm,3.0 cm×3.5 cm缩小为2.0cm×2.0 cm,1.0 cm×1.5 cm,有效时间分别为3、8个月.毒副反应包括Ⅰ度血白细胞减少1例,Ⅰ度贫血1例,Ⅰ度脱发1例,Ⅰ度恶心2例,Ⅱ度肝功能损害1例.结论EMP加Vp16治疗激素抵抗性前列腺癌有一定疗效,毒副反应轻.     

多西他赛联合雌二醇氮芥治疗激素抵抗性前列腺癌的疗效观察(附22例临床报道)

目的探讨多西他赛加雌二醇氮芥治疗去势抵抗性晚期前列腺癌的临床效果及不良反应。方法 22例去势抵抗性晚期前列腺癌患者,全部经手术去势及不同程度的抗雄激素药物治疗后病情缓解,之后病情再进展,经全身骨扫描证实均有多发性骨转移灶,其中17例伴不同程度的骨转移灶疼痛。治疗方法:多西他赛75mg/m2,第1天使用,雌二醇氮芥为420mg/d,第1~5天使用,每21天为一个疗程。结果 5例患者的血PSA值降至正常水平(PSA<4ng/L),12例PSA值下降超过50%,5例PSA值变化不明显。17例伴有骨转移灶疼痛的患者中有10例疼痛消失,7例疼痛患者按VRS分级分为Ⅰ级4例、Ⅱ级3例。随访时间为8~26个月,平均17.3个月。8例患者死亡,中位生存期为14.7个月,平均疼痛缓解期为12.5个月;PSA值降低的稳定期平均为11.8个月。本组病例最常见的不良反应是恶心呕吐、白细胞减少、血红蛋白降低及血小板减少等,但均在可耐受的范围。结论雌二醇氮芥加多西他赛全身化疗治疗去势抵抗性晚期前列腺癌的近期疗效显著,不良反应可以耐受,值得进一步观察研究。     

足叶乙甙联合环磷酰胺治疗雄激素抵抗性前列腺癌

目的　观察足叶乙甙(VP16)联合环磷酰胺治疗雄激素抵抗性前列腺癌的疗效。　方法　9例经全雄激素阻断治疗失败,且排除Flutamide撤药综合征的雄激素抵抗性前列腺癌患者采用VP16加环磷酰胺联合化疗,VP16 50mg/d,环磷酰胺100mg/d,连续服用21d, 28d为1周期。直至病情进展或毒副反应患者无法耐受。　结果　9例平均随访7. 5个月,PSA有效4例,PSA治疗前(90. 5±43. 6)ng/ml,治疗后(24. 8±22. 2 )ng/ml,平均有效时间6. 8个月, 5例可测量软组织转移灶有效2例,CR1例,PR1例。毒副反应轻微。　结论　Vp16加环磷酰胺治疗雄激素抵抗性前列腺癌有一定疗效,毒副反应可以耐受。     

晚期激素非依赖性前列腺癌临床化疗效果分析

目的探讨吉西他滨加顺铂(DDP)治疗晚期激素非依赖性前列腺癌的临床效果及毒副反应。方法26例晚期激素非依赖性前列腺癌患者,年龄53～76岁,中位年龄63岁。均经去势手术或(和)抗雄激素药物治疗,患者血PSA呈逐渐上升趋势。全身骨扫描证实均有多发性骨转移灶,其中20例出现不同程度的骨转移灶疼痛,疼痛按VRS分级,0级6例、Ⅰ级8例、Ⅱ级7例、Ⅲ级5例。肝脏、双侧。肾上腺和颅内转移各1例。吉西他滨1000 mg/m~2加生理盐水100 ml静脉滴注,第1、8天各1次;顺铂100 mg/m~2加生理盐水500 ml静脉滴注,第1天用,或者顺铂30 mg加生理盐水250 ml静脉滴注,第1～5天使用;每28 d为1个疗程。结果治疗后患者血PSA值降至正常水平(<4 ng/ml)1 8例,PSA值下降>50%5例,3例PSA值变化不明显,总有效率88%。20例骨转移灶疼痛者化疗后6例仍有疼痛,VRS分级Ⅰ级4例、Ⅱ级2例。1例多发性颅内转移灶其中最大转移瘤直径由化疗前的3.0 cm缩小至0.5 cm,化疗后面瘫症状消失。1例肝脏转移瘤由10.2 cm缩小至3.3 cm。1例双侧肾上腺转移瘤化疗后肿瘤体积缩小>2/3。随访6～52个月,平均30个月,15例患者死亡,中位生存期21.1个月。疼痛缓解期平均15.7个月。PSA值降低的稳定期平均14.5个月。常见毒副反应为恶心、呕吐、白细胞减少、血红蛋白降低及血小板减少等,但均在可耐受范围。结论吉西他滨联合顺铂全身化疗治疗晚期激素非依赖性前列腺癌的临床疗效显著,毒副反应较轻,可作为晚期激素非依赖性前列腺癌的一种辅助治疗方法。     

血清PSA含量及前列腺PSA密度与经直肠超声引导下前列腺穿刺活检诊断前列腺癌的关系

目的探讨经直肠超声引导下前列腺穿刺活检术前列腺癌检出率与血清前列腺特异性抗原(PSA)及血清前列腺特异性抗原密度(PSAD)的关系。方法对134例患者行经直肠超声引导下前列腺5区13针系统穿刺活检。根据PSA水平分为PSA≤4ng/ml组(7例)、4ng/mlPSA15ng/ml组(48例)及PSA≥15ng/ml组(79例)。测量并计算前列腺体积(PV)及PSAD,分析前列腺癌检出率及不同PSA、PSAD水平下对前列腺癌的诊断效能。比较前列腺癌与非前列腺癌患者PSA、PV及PSAD的差异。结果前列腺癌总检出率为50.75%(68/134),前列腺患者共68例(前列腺癌组),非前列腺癌患者共66例(非前列腺啊组)。PSA≤4ng/ml、4ng/mlPSA≤15ng/ml及PSA15ng/ml组前列腺癌检出率分别为14.29%(1/7)、20.83%(10/48)及72.15%(57/79),差异有统计学意义(P0.05)。PSA≥4ng/ml时前列腺癌检出率随着PSA值的增高而上升。134例患者PSAD值为(1.09±1.72)ng/(ml·cm3),以PSAD≥0.19ng/(ml·cm3)为截点诊断前列腺癌的敏感度为95.59%(65/68),特异度为51.52%(34/66),阳性预测值67.01%(65/97),阴性预测值为32.99%(32/97)。4ng/mlPSA≤15ng/ml组中,以PSAD≥0.19ng/(ml.cm3)为截点诊断前列腺癌的敏感度为80.00%(8/10),特异度为71.05%(27/38),阳性预测值为42.11%(8/19),阴性预测值为57.89%(11/19)。前列腺癌组PSA及PSAD值均高于非前列腺癌组(P均0.05),PV小于非前列腺癌组(P0.05)。4ng/mlPSA≤15ng/ml组中,前列腺癌与非前列腺癌患者PSA及PV差异均无统计学意义(P均0.05),前列腺癌患者PSAD高于非前列腺癌患者(P0.05)。结论血清PSA及PSAD均与前列腺穿刺活检前列腺癌检出率有关,PSA15ng/ml应行穿刺活检,PSAD对4ng/mlPSA≤15ng/ml的患者是否应行穿刺活检具有指导意义。     

比卡鲁胺治疗激素抵抗性前列腺癌

目的观察比卡鲁胺(bicalutamide,康士得,casodex)治疗激素抵抗性前列腺癌(HRPC)的疗效。方法经睾丸切除加氟他胺或福至尔治疗后前列腺特异性抗原(PSA)再次升高,病变进展的前列腺癌患者28例,年龄52～82岁。Gleason评分2～4分4例,5～6分7例,7～10分17例。临床分期C期6例、D期22例。比卡鲁胺治疗,50mg或150mg每日1次口服,疗程3～25个月,观察治疗前后血清PSA及临床症状的变化。结果比卡鲁胺治疗后,18例患者PSA由治疗前(92.6±34.5)ng/ml降至(32.6±11.4)ng/ml,持续4～22个月,平均8.5个月。其中10例患者PSA(27.2±6.0)ng/ml,下降>50%,临床症状改善8例,前列腺结节较前缩小7例,骨转移有好转5例。结论比卡鲁胺作为二线激素治疗药物对于激素抵抗性前列腺癌有一定疗效。     

多西他赛加泼尼松耐药的前列腺癌联合雌二醇氮芥治疗22例报告

目的 观察对多西他赛加泼尼松方案耐药的去势抵抗性前列腺癌(Castration-Resistant Prostate Cancer,CRPC)病例联合应用雌二醉氮芥的疗效和安全性.方法 CRPC患者22例在多西他赛加泼尼松治疗过程中病情进展(血PSA升高)时,用雌二醇氮芥联合多西他赛及泼尼松方案二线治疗:多西他赛75mg/m2,第1天,泼尼松5 mg bid,第1天起连续应用,雌二醉氮芥280mg bid,第1天起连用5d.21d为1周期.主要观察终点是PSA,PSA下降＞50%为有效.次要观察终点包括生化无进展生存期、总生存期、客观有效率及毒副作用.结果 22例患者共完成94个周期.有效14例,有效率64%.中位生化无进展生存期17.1周,中位总生存期54.3周.Ⅲ-Ⅳ度毒副作用包括心脏毒性1例(5%),中性粒细胞减少8例(36%),粒细胞缺乏性发热1例(5%).2例因毒副作用退出治疗.结论 雌二醇氮芥联合多西他赛及泼尼松二线治疗多西他赛加拨尼松方案耐药的CRPC患者疗效较好,毒副反应可以耐受,值得进一步观察研究.     

经直肠超声引导下“10+X”点法前列腺穿刺活检术在PSA值介于4～20ng/ml之间患者前列腺癌诊断中的价值

目的 探讨经直肠超声引导下“10 +X”前列腺穿刺活检术在PSA值介于4 ～20ng/ml之间患者前列腺癌诊断中的价值。方法 回顾性分析226例血清PSA值介于4～20ng/ml之间疑似前列腺癌患者临床资料,所有患者均行经直肠超声引导下前列腺穿刺术活检。结果 前列腺癌47例,前列腺增生158例,前列腺炎11例,前列腺上...     

经直肠超声引导下“6+X”点法前列腺穿刺活检术在PSA值＞20ng/ml患者前列腺癌诊断中的价值

目的 探讨经直肠超声引导下“6+X”前列腺穿刺活检术在PSA值＞20ng/ml之间患者前列腺癌诊断中的价值.方法 回顾性分析57例血清PSA值＞20ng/ml之间疑似前列腺癌患者临床资料,所有患者均行经直肠超声引导下前列腺穿刺术活检.结果 前列腺癌54例,急性前列腺炎3例.结论 经直肠超声引导下“6+X”前列腺穿刺活检是诊断PSA值＞20ng/ml之间患者前列腺癌的一种安全有效的检查方法.     

多西他赛联合内分泌治疗对转移性前列腺癌的疗效和安全性

目的探讨多西他赛联合内分泌治疗对远处转移性前列腺癌的疗效和安全性。方法回顾性分析2016年4月至2019年4月天津医科大学第二医院收治的204例远处转移性前列腺癌患者的临床资料。所有患者均伴有骨转移, 无内脏转移, 其中转移性激素敏感性前列腺癌(mHSPC)97例, 平均年龄70(42～87)岁;92例为高肿瘤负荷(存在>4处骨转移灶, 其中至少1处为脊柱或骨盆外转移), 5例为低肿瘤负荷;化疗前前列腺特异性抗原(PSA)中位值74.1(11.0～145.0)ng/ml;Gleason评分≤7分35例(36.1%), ≥8分62例(63.9%);26例存在骨痛症状, 疼痛数字评价量表(NRS)平均3.7分。转移性去势抵抗性前列腺癌(mCRPC)107例;平均年龄73(56～83)岁;化疗前PSA中位值84.5(12.4～490.2)ng/ml;Gleason评分≤7分32例(29.9%), ≥8分75例(70.1%);75例存在骨痛症状, 疼痛NRS平均5.4分。患者均采用多西他赛联合持续内分泌治疗(药物去势联合抗雄激素药物)。化疗方案为多西他赛75 mg/m2, 第l天静脉滴注...     

Safety and efficacy of docetaxel,estramustine phosphate and hydrocortisone in hormone‐refractory prostate cancer patients

Objective: To assess the combination of docetaxel (DTX), estramustine phosphate (EMP) and hydrocortisone for patients with hormone‐refractory prostate cancer (HRPC). Methods: A total of 63 patients with HRPC were treated with a chemotherapeutic regimen including DTX, EMP, and hydrocortisone. Clinical and pathological features were correlated to serum prostate‐specific antigen (PSA) recurrence and survival rates. Incidence and degree of toxicities were also retrospectively reviewed. Results: A median of 11 courses of chemotherapy was administered per patient. PSA levels decreased by >50% in 32 (51%) patients and >90% in 18 (29%) patients. Median time to PSA progression was 6 months (range from 1 to 41 months) and median time of overall survival was 14 months (range from 1 to 56 months). In a univariate analysis to predict overall survival, PSA, hemoglobin, alkaliphosphatase, and performance status prior to the chemotherapy were significant factors. Despite grade 3–4 neutropenia in 87% of patients, grade 5 interstitial pneumonia in one patient and grade 4–5 myocardial infarction in two patients were recognized, the regimen seemed to be relatively safe. Conclusions: Combination chemotherapy with DTX, EMP and hydrocortisone provides survival benefits for patients with HRPC with an acceptable toxicity profile. We need to further evaluate who might benefit most from this regimen.     

9-Nitrocamptothecin as second line chemotherapy for men with progressive, metastatic, hormone refractory prostate cancer: Results of the CALGB 99901

BACKGROUND: Institution of early hormone therapy in the PSA era coupled with demonstration of clinical benefit with chemotherapy in hormone refractory prostate cancer (HRPC) and acceptance of PSA decline as a surrogate for response has resulted in introduction of chemotherapy earlier in the natural history of disease. There now exists a need to identify, effective agents for second line chemotherapy. 9-nitrocamptothecin (9-NC) a novel, oral camptothecin analogue was tested as second line chemotherapy for patients with progressive hormone refractory prostate cancer. PATIENTS AND METHODS: Eligible patients had metastatic hormone refractory prostate cancer with performance status (0-1) following progression on at least 1 prior cytotoxic chemotherapy. 9-NC was administered orally at the dose of 1.5 mg/m2/d for 5 days each week for 3 weeks, followed by rest for 1 week. Response was evaluated after 2 cycles according to the guidelines set forth for Phase II trials in HRPC by the PSA working group. RESULTS: Thirty-five patients were recruited to the study within a period of 6 months; 33 were evaluable for analysis. No patients had a >50% decline in PSA levels. Two out of 8 (25%) patients with measurable disease and 5/25 (20%) patients with nonmeasurable disease showed stable disease. The median time to disease and PSA progression was 2 months [95% confidence interval (CI), 0.9-2.8]. The median overall survival was 10 months (95% CI = 5-12). Seven patients are alive after a median follow-up of 23 months. CONCLUSIONS: 9-nitrocamptothecin failed to elicit clinical or PSA responses. Further study in pretreated HRPC patients is not warranted.     

Prognostic significance of the nadir prostate specific antigen level after hormone therapy for prostate cancer

PURPOSE: We determine whether the nadir prostate specific antigen (PSA) level after hormone therapy can be used to predict the progression to hormone refractory prostate cancer. MATERIALS AND METHODS: We reviewed the progressive status and survival of 177 patients with stage C or D prostate cancer who had received hormone therapy at our institution. The overall survival rate, incidence of progression to hormone refractory prostate cancer and interval until progression were analyzed with reference to the nadir PSA level. Multiple regression analysis was used to analyze the predictive factors for progression to hormone refractory prostate cancer, and the relative efficacy of the nadir PSA level in predicting progression was evaluated by receiver operating characteristics analysis. RESULTS: Median followup was 39 months (range 3 to 89) and 85.4% of patients (151) responded to treatment, of whom 77.5% (117) had progression to hormone refractory prostate cancer. Median time until nadir PSA levels were reached after hormone therapy was 8.1 months and median time until hormone refractory prostate cancer was 24.0 months. Nadir PSA levels were less than 0.2 ng./ml. in 31% of respondents, 0.2 to 1.0 ng./ml. in 23%, 1.1 to 10 ng./ml. in 42% and greater than 10 ng./ml. in 5%. These groups had similar clinicopathological characteristics. Nadir PSA levels correlated significantly with pretreatment PSA levels, Gleason scores and progression to hormone refractory prostate cancer (p = 0.01, p <0.01 and p <0.001, respectively), and inversely correlated with the interval to the establishment of hormone refractory prostate cancer (r = -0.465, p <0.05). By univariate analysis bone metastasis, nadir PSA, PSA at 6 months after treatment and pretreatment PSA were significantly associated with progression to hormone refractory prostate cancer. Only the nadir PSA was calculated to be an independent factor by multivariate analysis. Receiver operating characteristics analysis indicated that nadir PSA predicted progression to hormone refractory prostate cancer after 2 years with an accuracy of 86.2%. With the lower limit of the nadir PSA level set to 1.1 ng./ml., sensitivity was 80.3% and specificity was 83.8%, and these levels were deemed the most appropriate. Furthermore, nadir PSA after hormone therapy was an independent prognosticator for survival, as were initial levels of hemoglobin and alkaline phosphatase. CONCLUSIONS: The nadir PSA level after hormone therapy may be the most accurate factor predicting the progression to hormone refractory prostate cancer and is an independent prognostic factor for survival. Furthermore, a lower limit for the nadir PSA level of 1.1 ng./ml. gives optimal sensitivity and specificity.     

125Ⅰ放射粒子植入治疗激素难治性前列腺癌

目的　探讨12 5I放射粒子植入治疗激素难治性前列腺癌的临床价值。　方法　直肠B超引导下 ,经会阴穿刺前列腺12 5I放射粒子植入治疗激素难治性前列腺癌 15例 ,其中 5例合并骨转移者同时行转移灶外放疗。　结果　 15例手术顺利 ,平均植入12 5I放射粒子 5 6粒 ,平均手术时间 70min ,平均住院时间 5d。术后随访 5～ 2 8个月 ,平均 11个月 ,完全反应 5例 ,部分反应 4例 ,病情稳定 3例 ,病情恶化 3例 ,PSA无进展生存率 80 % ( 12 /15 ) ,未发生严重并发症。　结论　12 5I放射粒子植入治疗激素难治性前列腺癌安全、微创、并发症发生率低 ,疗效肯定。     

Prospective randomised trial comparing diethylstilboestrol and flutamide in the treatment of hormone relapsed prostate cancer

BACKGROUND: Patients with hormone relapsed prostate cancer (HRPC) are often treated with flutamide or diethylstilboestrol. However, which of these two options is the best treatment for HRPC remains unclear. METHODS: We carried out a prospective study to determine and compare the prostate-specific antigen (PSA) response and survival in patients with hormone relapsed prostate cancer (HRPC), all of whom had previously shown a good response to medical or surgical castration. The patients were randomised to treatment with diethylstilboestrol (DES) and aspirin, or the antiandrogen flutamide. In addition, quality of life was determined by interview and questionnaire. RESULTS: Twenty-eight patients were randomised for treatment options.There was a significantly greater fall in the PSA (65% vs 35%; P = 0.034) after treatment with diethylstilboestrol compared to treatment with flutamide. Median survival also rose after treatment with diethylstilboestrol (18 months) compared to flutamide (11 months), but this difference did not reach statistical significance. There was no difference in the quality of life parameters between the two groups. There were no cardiovascular complications in the stilboestrol group. CONCLUSIONS: In HRPC, treatment with stilboestrol is associated with a greater PSA fall and an increase in median survival when compared to flutamide treatment.     

Survival of patients with hormone refractory prostate cancer in the prostate specific antigen era

PURPOSE: The historically reported 12 to 18-month duration of survival of patients with hormone refractory prostate cancer is not consistent with current clinical experience. Furthermore, to our knowledge patient survival after serum prostate specific antigen (PSA) progressively increases from a nadir despite castrate testosterone has not been previously reported. For this reason we studied overall survival and the clinical variables that influence survival in patients with hormone refractory prostate cancer. MATERIALS AND METHODS: The study focused on 254 patients with prostate cancer on androgen deprivation therapy. Hormone refractory prostate cancer was defined as the first in a series of PSA elevations despite castrate levels of testosterone. The duration of survival in the hormone refractory phase was calculated from the date of the first PSA elevation to the date of death. RESULTS: Median survival after hormone refractory prostate cancer developed in patients initially staged with and without skeletal metastasis was 40 and 68 months, respectively. Six of more than 25 input variables were retained as significant in the final Cox model. Variables associated with longer survival were lower nadir PSA, younger age, higher pretreatment testosterone, no history of obstructive uropathy, no history of tobacco use (past or current) and lower alkaline phosphatase. CONCLUSIONS: Historical reports of survival in hormone refractory prostate cancer underestimate current survival observations. The likely explanations of this observation include delayed enrollment in clinical trials from which most survival data are derived, PSA lead time in staging and improved supportive care. Models predicting survival in patients with hormone refractory prostate cancer should consider multiple variables.     

Prospective study of estramustine phosphate for hormone refractory prostate cancer patients following androgen deprivation therapy

INTRODUCTION: Estramustine phosphate (EMP) in combination with other cytotoxic agents has been widely used in clinical trials as an anti-tumor agent for the treatment of hormone-refractory prostate cancer (HRPC). However, few prospective studies have considered the efficacy of EMP monotherapy for HRPC patients following androgen-deprivation therapy (ADT), given the availability of methods to measure prostate-specific antigen (PSA) levels in the serum. We therefore initiated a prospective study to determine whether EMP is efficient for HRPC following ADT using changes in PSA levels as the major endpoint. METHODS: After a diagnosis of anti-androgen withdrawal syndrome had been excluded, 34 patients with HRPC who showed an elevated serum PSA level in 3 or more sequential tests following ADT were treated orally with 560 mg/day of EMP. The clinical stage and the median PSA value for inclusion in the study were D2 and 25.9 (range 6.5-540.8) ng/ml, respectively. Treatment was continued until evidence of disease progression reappeared or until severe adverse effects appeared. RESULTS: Of the 34 patients enrolled, 29 were evaluated, while the other 5 (15%) patients were discontinued due to severe gastrointestinal side effects. Seven of the 29 patients (24%) showed a decrease of 50% or greater in serum PSA levels from the initially elevated values, with the median duration of PSA response being 8.0 (range 2.2-18.8) months. Baseline PSA, hemoglobin, alkaline phosphatase, lactate dehydrogenase, performance status, and length of time of initial hormonal treatment did not correlate with the PSA response. With a median follow-up time of 20.0 (range 3.2-45.6) months, the cancer-specific survival rate at 2 years was 83% in the PSA responders and 44% in the non-responders. The PSA response was correlated with cancer-specific survival (p = 0.029). CONCLUSIONS: Following ADT one quarter of HRPC patients responded to EMP, with more than 50% of patients showing a decrease in PSA levels and an enhanced survival rate.     

Docetaxel-based chemotherapy with zoledronic acid and prednisone in hormone refractory prostate cancer: Factors predicting response and survival

Objectives:   To evaluate the efficacy of docetaxel/prednisone and zoledronic acid in hormone refractory prostate cancer (HRPC) patients and to analyze prognostic factors predicting overall survival.
Methods:   Forty-four HRPC patients were given docetaxel (75 mg/m²), prednisone and zoledronic acid (4 mg) every three weeks. Overall and progression-free survival curves were calculated. Using the log–rank test, variables predicting overall survival (age, Gleason score, baseline prostate-specific antigen [PSA], percentage PSA decline, nadir PSA, number of chemotherapy cycles) were calculated.
Results:   Median age was 66 years and mean PSA 171.25 ng/mL. The average number of given cycles was 6.3. A good PSA response (>50% decline) was observed in 26/44 cases (59.1%). A total of 17/44 (38.6%) patients expired with a median overall survival of 62.4 weeks. Patients with a Gleason score less than 7, who received more than four cycles and with a more-than-50% decline in PSA had significantly better survival. Variables like age, baseline PSA and nadir PSA did not significantly affect survival.
Conclusion:   The combination of docetaxel/zoledronic/prednisone is safe and effective in the management of HRPC. Patients with a Gleason score <7, PSA decline >50% and those who receive more than four cycles have significantly better survival.     

Survival outcomes in men receiving androgen‐deprivation therapy as primary or salvage treatment for localized or advanced prostate cancer: 20‐year single‐centre experience

OBJECTIVES

To evaluate the overall survival (OS) and disease‐specific survival (DSS) in men receiving primary androgen‐deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer.

PATIENTS AND METHODS

After Institutional Review Board approval, we retrospectively reviewed patients receiving ADT for prostate cancer between July 1987 and June 2007. Variables included age at diagnosis and ADT induction, race, PSA level before ADT, ADT schedule (continuous/intermittent), clinical/pathological stage, hormone‐refractory prostate cancer (HRCP) status, PADT or SADT, and deaths.

RESULTS

In all, 548 men were analysed. The mean age at diagnosis and ADT induction were 70.1 and 72.3 years, respectively, and 321 (58.6%) were African‐American. The median PSA level before ADT was 16.3 ng/mL. ADT was administered continuously in 497 (90.7%) patients; 342 (62.4%) received PADT while 206 (37.6%) received SADT. At mean (range) follow‐up of 81.8 (2.1–445) months, 98 (17.9%) deaths occurred; 31 (31.6%) were cancer‐specific. The OS and DSS in the PADT and SADT groups were not significantly different (P = 0.36 and P = 0.81, respectively). Mortality rates/distributions were similar between groups (P = 0.68). Multivariate predictors of OS and DSS included age at diagnosis (P = 0.03) and ADT induction (P = 0.009), tumour stage (P < 0.001), and PSA level at ADT induction (P = 0.01). Progression to HRPC worsened OS and DSS (both P < 0.001).

CONCLUSION

PADT and SADT prolong survival in men with prostate cancer. HRPC portends a poor DSS. Age at diagnosis and ADT induction, PSA level before ADT, and disease stage predict both OS and DSS in this population. However, most men died from causes unrelated to prostate cancer, thus questioning the true value of ADT in prolonging patient survival.     

Oral estramustine plus oral etoposide in the treatment of hormone refractory prostate cancer patients: a phase II study with a 5-year follow-up

BACKGROUND: Chemotherapy regimens that target microtubular trafficking were repeatedly found to be active in the treatment of hormone refractory prostate cancer patients, but disease responses were reportedly short-lived on average. MATERIALS AND METHODS: From 1994 to 1997, 46 consecutive patients with hormone refractory prostate cancer were enrolled in a multicenter Phase II trial of oral etoposide 100 mg/day and estramustine 560 mg/day for 21 days, followed by a 7-day rest period. Final evaluation of this trial was performed after a follow-up of 5 years. RESULTS: Fifty-four percent of patients attained a PSA response and 46% attained a response on measurable lesions. Median time to progression (TTP) and overall survival were 7.4 and 18.4 months, respectively. Fourteen patients (30.4%) had a TTP greater than 12 months and 9 (19.5%) a TTP greater than 18 months. Sixteen patients (34.8.%) survived more than 2 years and 2 (4.3%) survived more than 5 years. One patient was still alive and free from progression more than 7 years after starting treatment. CONCLUSIONS: This Phase II trial with a long-term follow-up revealed that some patients with hormone refractory prostate cancer could obtain durable disease response and long survival with an oral etoposide and estramustine combination regimen.