Redefining clinically significant castration levels in patients with prostate cancer receiving continuous androgen deprivation therapy
Redefining clinically significant castration levels in patients with prostate cancer receiving continuous androgen deprivation therapy
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DOI：
10.1016/j.juro.2007.05.129
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发表时间：
2007-10-01
影响因子：
6.6
通讯作者：
Catalan, Roberto
中科院分区：
文献类型：
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作者：
Morote, Juan;Orsola, Anna;Catalan, Roberto
目的：探讨持续雄激素剥夺治疗的前列腺癌患者睾酮去势水平的临床意义。次要目的是分析相关比卡鲁胺在这些患者血清睾酮突破性升高中的作用，以及最大限度雄激素阻断可能带来的益处。材料与方法：对73例接受药物去势治疗的非转移性前列腺癌患者进行3次（6个月内）血清睾酮测定，其中28例（38.4%）同时接受比卡鲁胺（最大雄激素阻断剂）治疗。在平均51个月（12 - 240个月）的随访期间，发现了41例（67.1%）雄激素非依赖性进展事件，并与睾酮突破50 ng/dl（经典水平）和20 ng/dl（手术阉割水平）相关。结果：32例（43.6%）患者睾酮水平均低于20 ng/dl。在23例（31.5%）患者中观察到20 - 50 ng/dl之间的突破性增长，其余18例（24.7%）患者中观察到超过50 ng/dl的增长。对无雄激素非依赖性进展的生存有显著影响的最低睾酮水平为32 ng/dl。突破增加大于32 ng/dl的患者无雄激素非依赖性进展的平均生存期为88个月（95% CI 55-121），而未突破增加的患者为137个月（95% CI 104-170） （p < 0.03）。接受最大雄激素阻断治疗的患者的睾酮发生率增加与接受单一治疗的患者相似。然而，最大限度的雄激素阻断在突破量大于50 ng/dl的患者中提供了更长的无雄激素非依赖性进展的生存期。结论：在目前的报告中，与临床相关的前列腺癌医学阉割患者的最低睾酮阉割水平为32 ng/dl。突破增加大于这个阈值预示着较低的生存无雄激素非依赖性进展。最大雄激素阻断可能有利于医学阉割的前列腺癌病例突破增加超过50 ng/dl。
Purpose: We determined the testosterone castration level with clinical relevance in patients with prostate cancer on continuous androgen deprivation therapy. Secondary objectives were to analyze the role of associated bicalutamide in breakthrough increases of serum testosterone in these patients and the possible benefit of maximal androgen blockade.Materials and Methods: Serum testosterone was determined 3 times (in 6 months) in 73 patients with nonmetastatic prostate cancer treated with medical castration, 28 (38.4%) of whom also received bicalutamide (maximal androgen blockade). During a mean followup of 51 months (range 12 to 240) 41 (67.1%) events of androgen independent progression were identified, and correlated with breakthrough testosterone increases of 50 ng/dl (classic level) and 20 ng/dl (surgical castration level).Results: Testosterone was less than 20 ng/dl in all determinations in 32 patients (43.6%). Breakthrough increases between 20 and 50 ng/dl were observed in 23 patients (31.5%), and increases greater than 50 ng/dl were observed in the remaining 18 (24.7%). The lowest testosterone level with a significant impact on survival free of androgen independent progression was 32 ng/dl. Mean survival free of androgen independent progression in patients with breakthrough increases greater than 32 ng/dl was 88 months (95% CI 55-121) while it was 137 months (95% CI 104-170) in those without breakthrough increases (p < 0.03). Patients on maximal androgen blockade had an incidence of testosterone increase similar to those receiving monotherapy. However, maximal androgen blockade provided a significantly longer survival free of androgen independent progression in those with breakthrough increases greater than 50 ng/dl.Conclusions: In the current report the lowest testosterone castration level with clinical relevance in medically castrated patients with prostate cancer was 32 ng/dl. Breakthrough increases greater than this threshold predicted a lower survival free of androgen independent progression. Maximal androgen blockade might benefit medically castrated cases of prostate cancer with breakthrough increases of more than 50 ng/dl.