Hormone/Antihormone Withdrawal and Dexamethasone for Hormone‐Refractory Prostate Cancer

International Journal of Urology - Tập 5 Số 1 - Trang 44-47 - 1998
Tsutomu Nishiyama1, Masahiro Terunuma1
1Department of Urology, Koseiren Nagaoka Chuo General Hospital, Nagaoka, Japan

Tóm tắt

Background Flutamide withdrawal has been reported to benefit patients with hormone‐refractory prostate cancer. Several studies have also demonstrated that a combination of corticosteroids and testicular androgen ablation lowers serum androgen levels and improves clinical response. The purpose of this study was to examine the effect of withdrawal of oral hormonal agents and administration of dexamethasone in stage D3 prostate cancer patients. Methods Sixteen patients with hormone‐refractory prostate cancer were enrolled in the study. All patients had osseous metastasis and elevated serum prostate‐specific antigen. Nine had been treated with chlormadinone acetate, 4 with estramustine phosphate, and 3 with flutamide as first‐line hormonal therapy. All patients had also been treated either with bilateral orchiectomy (13 cases) or a luteinizing hormone‐releasing hormone (LH‐RH) agonist (3 cases). Seven patients whose disease progressed following hormone withdrawal were treated with oral dexamethasone (initially 1.5mg/day, then tapered to 0.5 mg/day). Results Eight patients demonstrated a decrease in prostate‐specific antigen of greater than 50% following hormone withdrawal. The time to cancer progression for these 8 patients was 2 to 15 months (mean, 4 months). Among the patients receiving dexamethasone, 4 showed a greater than 90% decrease in prostate‐specific antigen after 3 months' treatment. The time to disease progression for these 4 patients was 3 to 11 months. Conclusion In treating hormone‐refractory advanced prostate cancer, the first pharmacologic manipulation should be withdrawal of the oral component of combined hormonal therapy. Patients whose disease progresses after hormone withdrawal should then be treated with glucocorticoids such as dexamethasone.

Từ khóa


Tài liệu tham khảo

Huggins C, 1941, Studies on prostate cancer. Effect of castration, estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate, Cancer Res, 1, 293

10.1056/NEJM198908173210702

10.1016/S0022-5347(17)36163-3

10.1200/JCO.1993.11.8.1566

10.1016/0090-4295(94)90092-2

10.1016/S0022-5347(01)67364-6

10.1016/S0022-5347(01)67365-8

10.1097/00000658-194512260-00012

10.1055/s-0029-1210905

10.1111/j.1464-410X.1990.tb14796.x

Japanese Urological Association and the Japanese Pathological Society, 1992, General rules for clinical and pathological studies on prostatic cancer, 9

10.1111/j.1442-2042.1994.tb00065.x

10.1016/S0090-4295(99)80070-3

Sekido N, 1995, Chlormadinone acetate withdrawal syndrome under combined androgen blockade for advanced prostate cancer, Jpn J Clin Oncol, 25, 164

10.1016/S0090-4295(96)80011-2

10.1016/S0006-291X(05)80067-1

10.1016/0039-128X(93)90084-Z

10.1016/S0090-4295(99)80182-4

10.1002/1097-0142(19950701)76:1<96::AID-CNCR2820760114>3.0.CO;2-E

Thông tin
Thông tin xuất bản

International Journal of Urology

Tập 5 Số 1

44-47

Thông tin tác giả