Intermittent More Complete Androgen Blockade in 5-year Tentative Treatment of Advanced Prostate Cancer T3NxMx-1
Article published in Urologia Polska 2005/58/1.
- Centrum Leczniczo-Rehabilitacyjne i Medycyny Pracy "ATTIS" w Warszawie
Konsultant ds. urologii: prof. nadzw. dr hab. Sławomir Dutkiewicz
prostate, prostate cancer, intermittent hormonal therapy, more complete androgen blockade mMAB
- aim of the study
- The aim of the study was to evaluate the efficacy and to assess the feasibility of pharmacological intermittent more complete androgen blockade (mMAB) in patients with advanced prostate cancer (T3NxMx-1).
- materials and methods
- The five-year study included 14 patients aged 67 to 82 years (average 73). Zoladex LA 10.8 mg was administered subcutaneously every 3th month of treatment, and 1 tablet Casodex and 1 tablet Proscar every day. At the time when PSA was <0.1 ng/ml Zoladex and Casodex were withdrawn, and only Proscar was left. The mMAB treatment was resumed when PSA rose to ł0.1 ng/ml. Before mMAB and at 3-month intervals, the following laboratory tests were performed: PSA, sedimentation, bilirubine, transaminase, phosphatase, ultrasonography (USG); all adverse events were recorded. After over 5 years, the results of the prospective study and the duration of the therapy and intermission were analysed. The following criteria of assessment were adopted: CR - complete response - examination tests normal, improved condition, reduction of prostate dimensions in USG and PSA value <0.1 ng/ml; PR - partial response i.e. no progression, PSA level decrease to the reference values and a reduction of prostate dimensions in USG; NR - no response i.e. progression, increased prostate dimensions in USG and/or metastases in scintigraphy, PSA above the normal range.
- The mean follow-up time of the prospective study was 60 months. After the initial 6 months, mMAB therapy was discontinued in two patients because they were qualified for radiotherapy. A successive patient (no. 5) was discontinued the therapy after 4 years because he left Warsaw to go abroad. The results of mMAB after 60 months were based on 11 patients' records, and a complete response was confirmed in 7 patients, partial response in 3 patients and no response in one patient. After the initial 12 months of mMAB, the mean off-therapy period duration was 10.8 months i.e. ranged from 3 to 18 months. The second therapy period duration ranged from 3 to 12 months (mean 6.3 months), 10 patients were responders and the mean off-therapy time in the second cycle was 12.1 months (from 3 to 20). The third cycle therapy ranged in duration from 3 to 15 months (mean 5.1 months) and the mean off-therapy period from 2 to 12 (mean 8.1).
- 1. Results of this study show that pharmacological intermittent mMAB is an efficient method of treatment in advanced prostate cancer.
- 2. Intermittent mMAB was associated with significant two off-therapy periods between two therapy cycles and with a chance of second hormonal response. However, the duration of the off-therapy period in the next cycle was short.
- 3. Side effects were of mild or moderate intensity and did not necessitate discontinuation of the therapy.
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