Clinical study on intermittent hormonal therapy for patients with prostate cancer / 北京大学学报(医学版)

ABSTRACT

Objective:To investigate the effect of intermittent hormonal therapy(IHT) for patients with different stage/grade prostate cancer(PCa).Methods:The number of cycles and the duration of ON/OFF therapy for 45 PCa patients receiving IHT were observed.Maximal androgen blockade(MAB) the-rapies were used for six to nine months,and then stopped until the serum prostate specific antigen(PSA) was decreased below 0.2 ?g/L,which lasted for three months.It was decided whether MAB went on according to the level of PSA.Results:The average follow-up time was 40.7?13.4 months.Forty-one patients started the second cycle of treatment,of whom,8 became androgen-independent and 7 were at T3-4M0 or M1 stages and the Gleason scores were above 8.Sixteen patients entered the third cycle,of whom,14 were at lower than stage Ⅲ and 13 had the Gleason scores below 7.From the first to the fourth courses of treatment,the average intervals were 8.7?5.4(47.1%),8.4?4.9(49.3%),7.0?3.4(43.7%),and 3.7?0.6(42.5%)months respectively.Five patients developed bone metastasis.No one died up to now.According to the evaluation criteria,patients were divided into tolerance(n=16) and intolerance groups(n=29).Compared with the intolerance group,the patients who tolerated the treatment well had lower Gleason scores(P=0.002),lower PSA levels(P=0.053) and lower tumor stages(P=0.001).There was no evidence that age,lymph node metastasis,bone metastasis and the state of recurrence were associated with an increased risk of the outcome.Non-conditional Logistic regression analysis showed that the proportion of patients at stage Ⅳ was the only independent risk factor for the tolerance of the treatment(OR=12.113,95%CI 1.330-110.312,P=0.027).Conclusion:Intermittent hormonal therapy is more effective and proper for the patient with highly differentiated tumor and at lower stages(≤Ⅲ).The patients who progressed to hormone-independence are mostly at stage Ⅳ with poorly differentiated tumor.Intermittent hormone therapy could be more adaptive for the patients at lower than stage Ⅲ.