Treatment of metastatic prostatic cancer with low-dose prednisone: evaluation of pain and quality of life as pragmatic indices of response.
Treatment of metastatic prostatic cancer with low-dose prednisone: evaluation of pain and quality of life as pragmatic indices of response.
复制标题
用低剂量泼尼松治疗转移性前列腺癌：评估疼痛和生活质量作为反应的实用指标。
DOI：
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发表时间：
1989
影响因子：
45.3
通讯作者：
W. Rider
中科院分区：
文献类型：
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作者：
I. Tannock;M. Gospodarowicz;W. Meakin;T. Panzarella;L. Stewart;W. Rider
37 名患有前列腺癌骨转移症状的男性，在早期使用雌激素和/或睾丸切除术治疗后病情进展，接受低剂量泼尼松治疗（每天 7.5 至 10 毫克）。这种治疗的基本原理是，一些患者可能仍然患有由肾上腺来源的弱雄激素刺激的激素敏感性疾病，而这些雄激素可以通过强的松对促肾上腺皮质激素（ACTH）分泌的负反馈来抑制。通过镇痛药的需求、McGill-Melzack 疼痛问卷以及一系列与疼痛和生活质量各个方面相关的 17 个线性模拟自我评估 (LASA) 量表来评估治疗反应。 14 名患者 (38%) 在开始使用泼尼松后 1 个月时用于评估疼痛的指数有所改善，7 名患者 (19%) 将这种改善维持了 3 至 30 个月（中位数为 4 个月）。疼痛的减轻与生活质量其他方面以及整体幸福感的改善相关。泼尼松治疗导致 9 名患者中有 7 名的血清睾酮浓度下降，最初未将其抑制在 2 nmol/L 以下，并导致超过 50% 的患者血清雄烯二酮和硫酸脱氢表雄酮水平下降。症状反应与肾上腺雄激素血清浓度降低有关。我们的结论是：（1）低剂量泼尼松可能有效缓解一些晚期前列腺癌患者的疼痛； (2) 疼痛的缓解与肾上腺雄激素的抑制有关； (3)疼痛和生活质量的测量可用于评估转移性前列腺癌患者全身治疗的可能益处。
Thirty-seven men with symptomatic bone metastases from prostate cancer that had progressed following earlier treatment with estrogens and/or orchidectomy were treated with low-dose prednisone (7.5 to 10 mg daily). The rationale for this treatment was that some patients might still have hormone-sensitive disease that was stimulated by weak androgens of adrenal origin, and that these androgens could be suppressed by prednisone through its negative feedback on secretion of adrenocorticotrophic hormone (ACTH). Response to treatment was assessed by requirement for analgesics, by the McGill-Melzack pain questionnaire, and by a series of 17 linear analog self-assessment (LASA) scales relating to pain and to various aspects of quality of life. Fourteen patients (38%) had improvement in indices used to assess pain at 1 month after starting prednisone, and seven patients (19%) maintained this improvement for 3 to 30 months (median, 4 months). Reduction in pain was associated with improvement in other dimensions of quality of life, and in the scale for overall well-being. Prednisone treatment led to a decrease in the concentration of serum testosterone in seven of nine patients where it was not initially suppressed below 2 nmol/L, and caused a decrease in serum levels of androstenedione and dehydroepiandrosterone sulfate in more than 50% of patients. Symptomatic response was associated with a decrease in serum concentration of adrenal androgens. We conclude that (1) low-dose prednisone may cause useful relief of pain in some patients with advanced prostatic cancer; (2) relief of pain was associated with suppression of adrenal androgens; and (3) measures of pain and quality of life can be used to assess possible benefits of systemic therapy in patients with metastatic prostate cancer.