醋酸阿比特龙治疗去势抵抗性前列腺癌早期出现PSA Flare现象的初步分析

A preliminary analysis of PSA Flare in early stage of castration-resistant prostate cancer treated with abiraterone acetate

目的分析我院泌尿外科治疗中心确诊为去势抵抗型前列腺癌(CRPC)患者、应用醋酸阿比特龙联合泼尼松治疗早期出现PSA Flare现象后对其前列腺特异抗原(PSA)缓解率的影响及部分基线值对PSA Flare出现概率的影响,为后续治疗提供经验。方法本研究共纳入2015年10月至2017年10月接受醋酸阿比特龙联合泼尼松治疗的CRPC患者共计86例,分析其中用药12周以上的55例有效病例的PSA基线值及其变化。结果 55例患者PSA总体缓解为56.4%,其中27.2%(15/55例)的患者出现了PSA Flare现象;PSA再次下降至基线值水平以下的中位时间为3.1(2~6)月。CRPC患者的年龄、PSA基线值、Gleason评分和患者出现PSA Flare现象无明确关联。结论对于醋酸阿比特龙联合泼尼松治疗CRPC患者来说,PSA Flare现象的发生比较常见,和患者年龄、PSA基线值、Gleason评分并无明确关联。在治疗早期药物暴露时间要足够,部分患者可能≥12周,个别患者PSA Flare持续时间达到24周,因此出现PSA Flare并不能说明疾病进展,对疾病进展的预估要结合影像学等多方面证据。

Objective To explore the effects of PSA Flare on the remission rate of prostate specific antigen（PSA）in patients with castration-resistant prostate cancer（CRPC）who were treated with abiraterone acetate combined with prednisone.Methods A total of 86 CRPC cases treated during Oct.2015 and Oct.2017 were included in the study.The changes of PSA in55 valid cases were analyzed.Results The overall remission rate of PSA was 56.4%,of which27.2%（15/55 cases）had PSA Flare,and the median time of PSA decrease to the baseline level was 3.1（2-6）months.There was no clear association between the age of patients,baseline PSA level,Gleason score and the occurrence of PSA Flare.Conclusion For abiraterone acetate combined with prednisone in the treatment of CRPC,PSA Flare is common.There is no correlation between PSA Flare and the age of patients,baseline PSA level and Gleason score.Patients should be exposed to drug treatment adequately.Some patients may need more than12-week treatment.In rare cases PSA Flare may last for 24 weeks.Therefore,PSA Flare does not mean the progression of the disease.Imaging data should be taken into consideration when the progression of disease is estimated.