间歇性雄激素阻断治疗晚期前列腺癌

目的:观察间歇性雄激素阻断治疗晚期前列腺癌患者的周期特点、疗效及副反应.方法:45例晚期前列腺癌行间歇性联合雄激素阻断治疗(LHRH类似物 非甾体类抗雄激素药物),持续用药至少4个月,至血前列腺特异抗原(PSA)降至最低值则停药进入间歇期,当PSA上升至初诊时的50%或大于10 ng/ml,则重新开始治疗.当发展为雄激素抵抗性前列腺癌或临床进展则停止治疗.结果:71.1%(32/45)患者完成第一个治疗周期,最多的已达4周期,间歇期占治疗周期的54%.随着重复治疗次数的增加每个周期发生疾病进展的比例也随之增加(P=0.006)且间歇期缩短(P＞0.05).患者三年进展率为53.1%,中位疾病进展时间为28.5个月,无骨转移患者和有骨转移患者三年进展率分别为23.61%和60.4%.间歇期副反应比治疗期明显减少.结论:间歇性雄激素阻断治疗晚期前列腺癌,间歇期长,疗效较好,副反应少,具有可行性,是一种较好的治疗方法.

Intermittent androgen blockade for the treatment of advanced prostate cancer

Objective: To investigate the cycling characteristics, the efficacy and side effect of total intermittent androgen blockade (IAB) for treating patients with advanced prostate cancer. Methods: Forty-five patients were treated with intermittent androgen blockade (LHRH analogue and nonsteroidal antiandrogen). Androgen blockade lasted 4 month at least. When PSA nadir level reached, drug would not be given and patient entered the intermittent period. Therapy was reinstituted after the serum PSA reached 50% or greater than that of pretreatment level or PSA greater than 10 ng/ml. Patient were no longer eligible to cycle of treatment if androgen independence prostate cancer occurred or any objective evidence of disease progressed. Result: 71.1%(32/45) patients completed the first cycle and patients with the longest follow-up performed four cycles.The intermittent cyole accouated for 54% of the therapeutic cycle. However, our results demonstrateted that as the time of therapeatic cycles increased, the progression rates of patients increased(P=0.006) and the intermittent cycle sholtened(P> 0.05). It was estimated that 3-year progression rate in our group was 53.1% and the median time to progression was 28.5 months. The estimated 3-year progression rates of patients without skeletal metastasis and of patients with skeletal metastasis were 23.61% and 60.4%, respectively .Side effects in the intermittent cyele ware obriousiy decreased than that in the therapeutic cycle.Conclusions: With long time of therapy, well efficacy and less side effects, intermittent androgen blockade was feasible for advanced prostate cancer and it is viable option.