Prostate-specific antigen in prostatic pathology

Prostate-specific antigen (PSA), like prostate acid phosphatase (PAP), are prostate tissue markers that are useful in prostate disorders. Increased PSA levels are often seen in carcinomas of the prostate, but have also been reported in benign inflammatory disorders of the prostate. We therefore studied PSA levels in 600 patients aged 22 to 89 years to evaluate the usefulness of this marker in prostate disorders. The 600 patients were divided into four groups: 120 normal subjects, 180 patients with carcinoma of organs other than the prostate, 75 patients with carcinoma of the prostate, and 225 patients with benign hypertrophy of the prostate. Results: a significant difference in PSA levels was found between carcinomas and adenomas of the prostate, as well as between stage A carcinomas and adenomas of the prostate. Conversely, non significant difference was evidenced between stage A carcinomas and benign prostatic hypertrophy with inflammation. Rather than a specific marker for cancer, PSA indicates the presence of active prostatic disease, other investigations being necessary to determine whether this disease is malignant. PSA remains extremely useful for monitoring prostate carcinoma patients, especially following radical prostatectomy.     

Risk Factors for the Development of Bone Metastases in Prostate Cancer

ObjectivesBone health of men with prostate cancer is threatened throughout the disease course. The majority of patients with advanced prostate cancer will develop bone metastases that can undermine skeletal integrity and result in skeletal complications including pathologic fractures, spinal cord compression, and palliative radiotherapy to bone. The early identification of patients who are at a high risk for bone metastases may enable earlier identification and treatment of bone lesions, thereby preserving patients’ independence throughout the disease course.MethodsCurrent guidelines for bone health maintenance were reviewed and PubMed key word searches performed to identify risk factors for the development of bone metastases in patients with prostate cancer. Additionally, guidelines and consensus recommendations were reviewed to identify bone health issues and their management in patients with early prostate cancer.ResultsCurrent prostate cancer monitoring guidelines recommend bone scans at initial diagnosis for patients with prostate-specific antigen (PSA) levels >20 ng/ml and in patients with chronic bone pain or fractures. Multiple studies have concluded that high baseline PSA levels, rising PSA despite androgen-deprivation therapy (ADT), and high PSA velocity are risk factors for the development of bone metastasis in patients with prostate cancer. In patients with early prostate cancer, bone loss is an emerging concern, and bisphosphonates have been demonstrated to prevent bone loss from ADT. Use of risk factors such as PSA kinetics may optimize screening and enable earlier identification of bone metastases.ConclusionsMonitoring bone mineral density may allow for better preservation of skeletal health in patients undergoing ADT.     

Evidence for the existence of an organ specific, androgen-independent pathway of progression in patients with metastatic prostate cancer

Ample clinical and preclinical data support the central role of bone-epithelial interaction in the progression of prostate cancer. The clinical progression of prostate cancer has been partially attributed to a cascade of interactions between the cancer compartment and microenvironment compartments. The expression of prostate specific antigen (PSA) parallels the activity of the epithelial compartment of prostate cancer. However, the clinical study of the bone-epithelial interaction has been limited by the lack of accessible relevant human tissue for study. This study was designed (1) to assess the value of human bone marrow as a source of tissue to study the bone-epithelial interaction and (2) to determine whether bone marrow supernatant regulates the expression of PSA in a human prostate cancer cell line (LNCaP) in vitro. The acellular bone marrow supernatant derived from patients with prostate cancer with different degrees of tumor spread, hormonal status, and histology were assayed for their ability to induce PSA expression in a human LNCaP. The bone marrow supernatants were derived from 53 patients with prostate cancer (49 with adenocarcinoma and 4 with small cell carcinoma) and eight control patients, who had cancers in other sites. In addition, the match serum specimens derived from 25 of the study patients also had been assayed for its PSA inductivity. In addition to the comparison with "static" serum and BM concentration of PSA, the rate of significant PSA induction by clinical stage and hormonal status was assessed. Patients with androgen-independent disease had the highest rate of PSA-inducing ability. Only two patients (8%) had weak PSA-inducing ability from their serum (both with high volume disease) and none of the bone marrow supernatants derived from patients without prostate cancer or small cell carcinoma had inducing ability. No correlation between the static BM or serum PSA concentrations and the inducing ability was seen. These results indicate that PSA expression can be regulated by androgen-independent factors. The bone marrow supernatant of patients with prostate cancer has unique properties and is a valuable source of tissue for clinical study of the progression of prostate cancer. These preliminary data suggest that induction of PSA by bone marrow supernatant should be studied for its clinical utility as an assay for the interaction between the epithelial and bone compartments, and it supports the existence of androgen-independent pathways of PSA regulation by the bone marrow supernatant of patients with advanced prostate cancer. If confirmed, these findings would support the use of bone marrow supernatant to study the osseous specific progression of prostate cancer.     

The detection of prostate specific antigen, MHS-5, and other markers in invasive prostate cancer and seminal vesicle.

Prostate specific antigen (PSA) is the most useful serum marker for following the disease status of prostate cancer patients after therapy. While PSA is felt to be an organ specific marker, lack of PSA expression in the seminal vesicles has not been adequately established. MHS-5 is a monoclonal antibody which recognizes an epitope on seminal vesicle specific antigen. Our objectives were to define PSA expression by the seminal vesicles, to determine whether MHS-5 could serve as an adjunct in the diagnosis of seminal vesicles invasion by carcinoma of the prostate, and to determine whether carcinoma, having invaded seminal vesicles would retain its expression of PSA and other prostate markers. Using an immunoperoxidase procedure, we studied thirteen seminal vesicles without histologic evidence of prostate cancer invasion and five seminal vesicles with locally invasive cancer. No seminal vesicles expressed PSA, whereas prostate cancer invading the seminal vesicles expressed PSA in all cases. MHS-5 expression was more variable. Only two of five cases of locally invasive tumor demonstrated seminal vesicles expression for MHS-5. Our findings further support the specificity of PSA. While MHS-5 may be helpful in delineating seminal vesicles in some instances, it is not a consistently reliable marker.     

The role of imaging studies and molecular markers for selecting candidates for radical prostatectomy

For the typical patient who has newly diagnosed prostate cancer, clinically organ-confined disease of moderate grade, and a PSA less than 10 ng/mL, the current role of imaging studies and molecular biomarkers is limited. Bone scans are not necessary for newly diagnosed men with a PSA less than 10 ng/mL in the absence of bone pain. Similarly, abdominal and pelvic CT scanning rarely provides any useful diagnostic or staging information when the PSA is less the 20 ng/mL and is indicated rarely. Endorectal coil MR imaging adds staging information for patients with a PSA between 10 and 20 ng/mL, a Gleason score of 7 or less, and 50% or more positive biopsies on a sextant sampling. Indium 111 capromab pendetide scanning (ProstaScint) is FDA-approved to evaluate newly diagnosed patients at high risk for metastases. These patients have a Gleason score of 7 or greater and a PSA greater than 20 ng/mL, a Gleason score of 8 to 10 regardless of the PSA value, or clinical stage T3 disease and a Gleason score of 6 or greater. RT-PCR testing of blood or bone marrow for prostate-specific or prostate cancer-specific gene expression, or "molecular staging," is a promising technique whose current use is still investigational. Much useful information may be gained by careful study of prostate needle biopsy material. Aside from current Gleason grading and the number or percentage of cores involved with cancer, no molecular biomarker is approved for clinical use. p27, p53, bcl-2, Ki-67 (MIB-1), and the assessment of neovascularity hold promise, but prospective multicenter studies are needed. In the long-term, multiple gene expression profiling of biopsy material using gene chips may revolutionize the care of patients with prostate cancer and those who elect radical prostatectomy.     

Scintigraphy in the foot and ankle

Nuclear medicine provides a number of sensitive, although unfortunately not always specific techniques, for the evaluation of foot pain and suspected infection. In most patients the 3 phase bone scan is the initial means of evaluation, with a labeled white cell scan included when osteomyelitis is suspected. Nuclear medicine studies must be interpreted with knowledge of the patient's history and symptoms and with close correlation to plain film findings. Attention to detail when acquiring images, possibly with the addition of SPECT or pinhole images in difficult patients, results in excellent anatomic localization in most patients.     

High dose intravenous oestrogen (fosfestrol) in the treatment of symptomatic, metastatic, hormone-refractory carcinoma of the prostate

Objective High dose intravenous stilboestrol has a direct cytotoxic effect on prostatic carcinoma cells. The purpose of this study was to assess subjective and objective responses in a select group of patients with metastatic, hormonerefractory carcinoma of the prostate with severe generalized bone pain in association with symptoms of advanced local disease. Patients and methods Seventeen patients with metastatic carcinoma of the prostate, who had relapsed following a good initial response to androgen ablation, were treated as inpatients with once daily intravenous injection of 1104 mg diethylstilboestrol diphosphate (Honvan^™, Asta Medica, Cambridge, UK) for 7 days. The hormone-refractory status was confirmed by castrate serum testosterone levels. All the patients had failed to respond to second-line hormone manipulation and had progressive disease. All the patients had generalized bone pain, 11 also had symptoms of bladder outlet obstruction, 3 had recurrent haematuria and 3 had both. The mean age was 74 years (range 59–83), mean time to chemical relapse (rising PSA) was 29 months (range 1–70), and mean time to clinical relapse was 37 months (range 6–98). The WHO pain score, performance status score, and a patient-specific quality of life (daily living activity) were used as the subjective measures and the serum PSA as an objective marker. All the parameters were recorded before, during and up to three months after treatment. Results Two patients had a transient relief of bone pain with the pain score reducing by two points. Overall, the pain and performance scores and the local symptoms did not improve. The PSA level continued to rise in all patients. Despite parenteral pre-medication with pethidine and cyclizine, all the patients suffered nausea and pain following the injection. One patient died on the fifth day of treatment from a myocardial infarction and 4 developed deep vein thrombosis. All the patients required further symptom control measures. Conclusion High dose intravenous stilboestrol causes considerable morbidity without any objective or subjective response in the treatment of patients with symptomatic, hormone-refractory metastatic carcinoma of the prostate.     

Clinical evaluation of low dose glucocorticoid therapy for hormone-refractory prostate cancer

Fifteen cases with hormone-refractory metastatic carcinoma of the prostate were treated by the combination therapy of LH-RH analogue and low-dose glucocorticoid. Prior treatments of the patients were composed of maximum androgen blockade (MAB) therapy (14 cases) and bilateral orichiectomy (1 case). Nine of 15 cases underwent estramustine based treatment or anti-cancer chemotherapy as the second-line therapy. As a glucocorticoid (steroid) therapy, 1.5 or 2.0 mg of dexamethasone or 10 mg of predonisolone were given for a median period of nine months. Clinical responses were evaluated by the determination of serum PSA, EOD score and QOL scales. PSA responses were classified as CR, PR and PD according to the following categories; CR : PSA level decreased to less than 2 ng/ml, PR : PSA level decreased to less than half values of pretreatment level, PD: 20% or more increased to pretreatment level. PSA responses (CR + PR) were observed in eight of 15 patients for a median period of six months. Responses are seemed to be correlated with the Gleason scores. No apparent improvement on EOD scores by bone scintigraphy was seen, however, definite improvement of bone pain was identified in eight of 11 cases. The steroid therapy was considered as one of the useful treatment choice for patients with hormone-refractory prostate cancer.     

The assessment of PTEN tumor suppressor gene in combination with Gleason scoring and serum PSA to evaluate progression of prostate carcinoma

OBJECTIVE: The purpose of the study was to determine if the tumor suppressor gene phosphate and tensin homolog (PTEN) (mutated in multiple advanced cancers 1) in combination with Gleason scoring and serum prostate specific antigen (PSA) could be employed to better predict the progression of prostate carcinoma. MATERIALS AND METHODS: The study group consisted of 43 patients with benign prostate hyperplasia (BPH), 15 with organ confined prostate carcinoma (OCPCa), and 18 with advanced prostate carcinoma (APCa). Prostate tissue samples were obtained from radical prostatectomy, transurethral resection, and TRUS guided trans-rectal needle biopsy and then evaluated for biomarker expression. The clinical stage was assessed according to tumor node metastasis classification and grade according to Gleason system. Serum PSA was measured by conventional techniques and Western blotting analysis was used to determine PTEN expression in the primary tissue. Multivariate analysis was performed to analyze whether these markers could individually predict the progression of prostate carcinoma. RESULTS: APCa patients displayed higher Gleason scores and serum PSA levels. But much lower PTEN expression was detected in prostate of APCa patients compared to patients with BPH or OCPCa. Hormone refractory (HR) and hormone sensitive (HS) APCa cases did not yield any significant differences in terms of Gleason scoring, serum PSA and PTEN expression. PSA levels were significantly higher in patients with OCPCa or APCa compared to patients with BPH. CONCLUSION: Our results suggested that both PTEN and serum PSA appeared to be useful as independent markers to depict the nature of tumor behavior as benign or malign. In addition, PTEN also appeared to be useful as an independent marker to predict the progression of prostate carcinoma.     

Diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer: Current practice

Nuclear medicine techniques continue to be important non-invasive imaging tools assisting the diagnosis, monitoring and--in some cases--treatment of prostate cancer. Bone scintigraphy was the premier modality to have an extensive role in the staging of prostate cancer and has remained an integral tool for over three decades in the assessment of newly diagnosed disease or in follow-up staging. Therapeutic treatment and palliation of disseminated disease, particularly in the skeleton, has also been successful with several radioisotopes including strontium-89 chloride. Despite advances in nuclear medicine techniques and molecular imaging technology such as positron emission tomography and radioimmunoscintigraphy, bone scintigraphy still remains the gold standard in the assessment of osseous metastatic disease in prostate cancer. Thus, it is important to continually review the modalities that have remained important over time and not just to focus on newer technologies. This article summarizes the current diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer with particular reference to radionuclide bone scintigraphy and positron emission tomography.     

Usefulness of extension of disease as a prognostic factor in relapsed prostate cancer patients of stage D

OBJECTIVE: The prognosis of prostate cancer has been evaluated by clinical stage or pathological grade. PSA parameters including PSA density and PSA doubling time have not always precisely reflected the prognosis of prostate cancer. The aim of this study was to evaluate PSA parameters and extension of disease (EOD) grade as prognostic factors for relapsed prostate cancer. METHODS: The relationship between PSA parameters or EOD grade, and survival of 29 stage D patients with relapsed prostate cancer after initial hormone therapy was examined. RESULTS: Only EOD grade was an independent prognostic factor, even for cause-specific survival period and survival period after relapse. CONCLUSION: EOD grade was a significant prognostic factor, and in particular, very useful as a prognostic factor for patients with bone metastasis. PSA value was not always associated with tumor volume, and therefore it is not an independent prognostic factor.     

COMPARISON OF HELICAL COMPUTERIZED TOMOGRAPHY, POSITRON EMISSION TOMOGRAPHY AND MONOCLONAL ANTIBODY SCANS FOR EVALUATION OF LYMPH NODE METASTASES IN PATIENTS WITH PROSTATE SPECIFIC ANTIGEN RELAPSE AFTER TREATMENT FOR LOCALIZED PROSTATE CANCER

PURPOSE: We compare the detection of metastatic disease by helical computerized tomography (CT), positron emission tomography (PET) with F-18 fluorodeoxyglucose and monoclonal antibody scan with 111indium capromab pendetide in patients with an elevated prostate specific antigen (PSA) after treatment for localized prostate cancer. MATERIALS AND METHODS: A total of 45 patients with an elevated PSA (median 3.8 ng./ml.) were studied following definitive local therapy with radical prostatectomy in 33, radiation therapy in 9 and cryosurgery in 3. CT of the abdomen and pelvis, and whole body PET were performed in all patients, of whom 21 also underwent monoclonal antibody scan. Lymph nodes 1 cm. in diameter or greater on CT were considered abnormal and were sampled by fine needle aspiration in 12 patients. RESULTS: PET and CT were positive for distant disease in 50% of 22 patients with PSA greater than 4, and in 4 and 17%, respectively, of 23 with PSA less than 4 ng./ml. The detection rate for metastatic disease was similar for CT and PET, and higher overall than that for monoclonal antibody scan. Monoclonal antibody scan was true positive in only 1 of 6 patients, while PET was true positive in 6 of 9 with CT guided fine needle aspiration proved metastases. CONCLUSIONS: CT and PET each detected evidence of metastatic disease in 50% of all patients with a high PSA or PSA velocity (greater than 4 ng./ml. or greater than 0.2 ng./ml. per month, respectively). Both techniques are limited for detecting metastatic disease in patients with a low PSA or PSA velocity. Our data suggest that monoclonal antibody scan has a lower detection rate than CT or PET.     

Ultrasonically guided transperineal biopsy in the diagnosis of prostatic carcinoma

Radiotherapy often is used for palliation of bone pain from metastatic cancer of the prostate but an objective evaluation of its efficacy in a large series of patients is unavailable. We report the results of external beam irradiation in 62 patients who had bone pain secondary to stage D carcinoma of the prostate. The variables used to judge pain before and after radiotherapy included subjective evaluation of pain, status of activity and quantitation of analgesic use. Complete relief of pain was achieved in 26 patients (42 per cent), partial relief in 22 (35 per cent) and no relief in 14 (23 per cent). On the basis of our experience external beam irradiation is useful palliative therapy for pain from metastatic cancer of the prostate.     

Evaluation of prostate-specific antigen and prosttic acid phosphatase as prostate cancer markers

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) have been evaluated in patients with prostate cancer, benign prostatic hypertrophy (BPH), and prostatitis. PSA has proved to be diagnostically more sensitive than PAP for the detection of prostate cancer: 95.0 per cent vs 60.0 per cent for 40 newly diagnosed cancer cases, and 97.1 per cent vs 65.7 per cent for 35 relapsed cases. This also holds true for those patients with early-stage disease: 71.4 per cent vs 0 per cent for 7 Stage A1 cases. The specificities of PSA and PAP are comparable, 96.8 per cent vs 98.9 per cent, respectively. PSA is also more sensitive for monitoring therapy, since it usually rises before PAP and always precedes clinical signs of relapse. Although PSA may be elevated more frequently than PAP in some patients with BPH and prostatitis, it is postulated that these patients with elevated serum PSA and normal serum PAP may fall into a high-risk sub-population which may have early prostate cancer or precancerous conditions not easily detectable by current clinical and diagnostic techniques. Our data suggest PSA is a sensitive useful tumor marker for the diagnosis and management of prostate cancer. In addition, PAP, in combination with PSA, may serve as a useful adjunct for differential diagnosis and confirmation of advanced stage prostate cancer.     

Evaluation of prostate-specific antigen and prostatic acid phosphatase as prostate cancer markers

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) have been evaluated in patients with prostate cancer, benign prostatic hypertrophy (BPH), and prostatitis. PSA has proved to be diagnostically more sensitive than PAP for the detection of prostate cancer: 95.0 per cent vs 60.0 per cent for 40 newly diagnosed cancer cases, and 97.1 per cent vs 65.7 per cent for 35 relapsed cases. This also holds true for those patients with early-stage disease: 71.4 per cent vs 0 per cent for 7 Stage A1 cases. The specificities of PSA and PAP are comparable, 96.8 per cent vs 98.9 per cent, respectively. PSA is also more sensitive for monitoring therapy, since it usually rises before PAP and always precedes clinical signs of relapse. Although PSA may be elevated more frequently than PAP in some patients with BPH and prostatitis, it is postulated that these patients with elevated serum PSA and normal serum PAP may fall into a high-risk sub-population which may have early prostate cancer or precancerous conditions not easily detectable by current clinical and diagnostic techniques. Our data suggest PSA is a sensitive useful tumor marker for the diagnosis and management of prostate cancer. In addition, PAP, in combination with PSA, may serve as a useful adjunct for differential diagnosis and confirmation of advanced stage prostate cancer.     

Value of the serum prostate-specific antigen-alpha 1-antichymotrypsin complex and its density as a predictor for the extent of prostate cancer.

OBJECTIVE: To determine whether serum levels of the prostate-specific antigen-alpha1-antichymotrypsin complex (PSA-ACT) and its density (ACTD) in patients scheduled to undergo radical prostatectomy for clinically localized prostate cancer can predict organ-confined vs extraprostatic disease. PATIENTS AND METHODS: Serum samples were obtained from 62 patients with clinically localized prostate cancer before they underwent radical prostatectomy. PSA and PSA-ACT were measured using immunofluorometric techniques with different monoclonal antibodies against PSA and ACT, respectively. Furthermore, the PSA and PSA-ACT densities of the whole prostate (PSAD and ACTD, respectively) were calculated. The relationships of serum PSA, PSA-ACT, PSAD, ACTD and the pathological stage of the prostatectomy specimens were analysed. RESULTS: The disease was organ-confined or extraprostatic in 30 and 32 men, respectively. In men with organ-confined cancer, the mean PSA and PSA-ACT levels were significantly lower than in those with extraprostatic disease. Furthermore, there were significantly higher mean PSAD and ACTD levels in men with extraprostatic than with organ-confined disease. There were also significant differences in PSA, PSA-ACT, PSAD and ACTD levels at each pathological stage, whereas there was no significant association between these variables and the Gleason score. Receiver-operating characteristic curve analysis for detecting organ-confined disease showed that PSA-ACT and ACTD had a larger area under the curve than PSA and PSAD, respectively, but these differences were not significant. Furthermore, PSA-ACT and ACTD provided significantly better sensitivity for detecting organ-confined disease than PSA and PSAD, respectively. CONCLUSIONS: Measuring PSA-ACT and ACTD may improve the preoperative evaluation of patients scheduled to undergo radical prostatectomy, because these factors better differentiate extraprostatic from organ-confined disease than PSA and PSAD.     

The role of prostate specific antigen in the baseline assessment of patients undergoing hormone therapy for advanced prostate cancer

One hundred and thirty-nine patients with advanced prostate cancer were entered into a randomised trial to test the efficacy and tolerance of goserelin 3.6 mg depot (Zoladex) versus stilboestrol 3 mg/day. As well as the usual clinical and radiological assessments of extent of disease, we used an immunoradiometric assay of prostate specific antigen (PSA) (Hybritech Europe) and normal laboratory enzymatic assays of acid phosphatase (AP) and alkaline phosphatase (ALKP) for biochemical assessment. The upper limit of normal for PSA was taken as 10 micrograms/l. The range of PSA was wide and differed significantly from that of AP and to a lesser extent ALKP in metastatic cases. PSA outperformed both AP and ALKP in both the local and advanced groups in terms of sensitivity. There was no correlation, however, between histological grade and level of PSA, AP or ALKP (the latter in cases with bone disease). In patients with metastatic disease diagnosed by bone scan, nine patients had one abnormal site/one "hot spot", and all of these had a PSA greater than twice the normal upper limit. Early death due to prostate cancer was noted in four patients with levels of PSA greater than 2500 micrograms/l. PSA is more sensitive than either enzymatic AP or ALKP in both locally advanced and metastatic prostate cancer and is useful in identifying those advanced cases who have single lesions on bone scan. In this series PSA gave an overall sensitivity of 89%, compared with 63% for AP and 64% for ALKP in patients with metastatic disease.     

Tamoxifen for flutamide/finasteride-induced gynecomastia

Objectives

Current therapies for advanced prostate carcinoma lead to a marked decrease in serum testosterone levels, which renders patients impotent. In preliminary studies, combination therapy with flutamide and finasteride has been used as an alternative therapy for the treatment of prostate carcinoma because potency can be preserved. Both of these agents can cause gynecomastia and breast/nipple tenderness.

Methods

Six men being treated for advanced prostate carcinoma with flutamide/finasteride combination therapy developed painful gynecomastia, which was treated with tamoxifen 10 to 30 mg/day for 1 month. Clinical follow-up included breast measurements and determination of prostate-specific antigen (PSA), testosterone, and estradiol levels.

Results

While on this combination therapy for prostate carcinoma, 4 of 6 patients experienced a decrease in PSA level to less than 0.5 ng/mL. All patients remained potent. Serum testosterone increased in each patient who had a baseline level drawn. Estradiol levels were noted to be elevated in 4 of 6 patients at the time of evaluation for gynecomastia. After treatment with tamoxifen, circulating estradiol levels increased in 3 patients from 1.3 to 2.2 times the baseline level. Five patients experienced complete resolution of breast and nipple pain on tamoxifen 10 mg/day within the first month. The other patient had to be treated with 30 mg/day for 1 additional month, which subsequently resulted in pain resolution.

Conclusions

These preliminary results suggest that low-dose tamoxifen is useful in treating painful gynecomastia for those patients on flutamide/finasteride combination therapy for advanced prostate carcinoma.     

Bisphosphonate and low-dose dexamethasone treatment for patients with hormone-refractory prostate cancer

We evaluated the effects of bisphosphonate (BP) treatment in five patients with hormone-refractory prostate cancer (HRPC), experiencing bone pain from metastases to the bone, and assessed changes in serum prostate specific antigen (PSA) levels, bone pain, and quality of life (QOL). Treatment with incadronate disodium (10 mg) in saline was administered at 2-week intervals for a total of 6 times. Evaluation of the treatment included the incidence of adverse events, QOL, bone pain, pain scale, and blood analyses including tumor markers. BP treatment was generally well tolerated by all five patients. The effects of BP treatment on serum PSA values were evaluated as prominent response (PR), no change (NC) and progressive disease (PD) in one, two and two cases of PD, respectively. During BP treatment, serum type I procollagen values decreased in patients, but there was no large change in serum type I collagen values. Only one patient experienced increased pain; pain was well controlled in the others. The QOL evaluation by Short-Form 36 (SF-36), showed no change in scores during BP treatment except for general health. These results suggested that BP treatment is safe and feasible. It may be effective for the treatment of those HRPC patients with bone pain and may become one of the choices for treatment of HRPC.     

125Ⅰ放射性籽源植入术联合内分泌疗法治疗前列腺癌的疗效评价（附29例报告）

目的：初步评价125Ⅰ放射性籽源植入术联合内分泌疗法治疗前列腺癌的临床疗效.方法：应用术中经直肠超声引导及治疗计划系统软件经会阴穿刺植入125 Ⅰ放射性籽源并同期行手术去势或药物去势治疗前列腺癌患者29例.结果：术后6个月～5年随访,发现29例患者前列腺体积及前列腺特异抗原（PSA）均有不同程度降低,8例淋巴结转移患者及4例骨转移患者转移灶均缩小,术前骨痛及排尿症状均有好转,且无一例出现尿潴留及便血等严重并发症.结论：125Ⅰ放射性籽源植入术并内分泌疗法对各期前列腺癌均有明显的治疗作用,是一种安全有效的前列腺癌综合治疗手段.