间歇性雄激素阻断治疗晚期前列腺癌

Intermittent androgen blockade for the treatment of advanced prostate cancer

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。

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.