促黄体生成激素释放激素拟似剂的转换治疗局部晚期前列腺癌生化进展

Efficacy of luteinizing hormone-releasing hormone agonist switching to treat the biochemical progression of advanced prostate cancer

目的探讨在长期进行促黄体生成激素释放激素拟似剂(LHRH-A)去势治疗的局部晚期前列腺癌患者出现生化进展后,转换为其他LHRH拟似剂治疗后的有效性。方法 37例采用戈舍瑞林或亮丙瑞林进行去势治疗的前列腺癌患者出现生化进展后,依据其药物转换前注射的LHRH-A的种类进行LHRH拟似剂的转换。26例既往行戈舍瑞林3.6 mg治疗者转换为亮丙瑞林3.75 mg,每28天皮下注射(GA-LA组);11例既往亮丙瑞林治疗者转换为戈舍瑞林3.6 mg,每28天注射(LA-GA组)。每月复查前列腺特异性抗原(PSA)及血清睾酮水平,并进行简明疼痛评分表调查。结果 GA-LA组16例(61.54%)转换后出现PSA下降,最大PSA下降比率50.81%。LA-GA组转换后7例(63.64%)出现PSA下降,最大PSA下降比率48.22%。相同时间点两组间PSA下降比率均无统计学差异。转换前2例血清睾酮水平大于40 ng/dl,转换后血清睾酮均降至40 ng/dl以下。相同时间点GA-LA组与LA-GA组之平均睾酮水平亦无统计学差异。研究期间无患者出现疼痛进展/缓解。结论对于正在长期进行LHRH-A治疗的局部晚期前列腺癌患者,出现PSA升高时,对现用的LHRH拟似剂进行种类的转换,可使部分患者PSA进展得到短期控制而获益,延缓进展至去势抵抗性前列腺癌的时间。

Objective To investigate the efficacy of luteinizing hormone-releasing hormone agonist（ LHRH-A） switching to treat the biochemical recurrence of advanced prostate cancer. Methods Thirty-seven advanced prostate cancer patients who received goserelin or leuprolide treatment and had biochemical progression were rechallenged with the other LHRH-A. The patients were divided into GA-LA group（ goserelin followed by leuprolide,n = 26） and LA-GA group（ leuprolide followed by goserelin,n = 11）. Serum prostatic specific antigen（ PSA）,testosterone and pain evaluation were achieved following the switching treatment. Results PSA decreased in 16 patients（ 61. 54%） in GA-LA group and 7 patients（ 63. 64%） in LA-GA group after the LHRH-A switching. The maximum decreases of PSA were 50. 81% and 48. 22% in GA-LA group and LA-GA group,respectively. There were no significant differences in PSA decrease rate and serum testosterone level between two groups at any time points. No pain progression occurred during follow-up. Conclusion Some advanced prostate cancer patients with PSA progression after long term LURH-A treatment would benefit from LHRH-A switching for a short term,which delays the development of castration resistant prostate cancer.