Treatment strategy for metastatic prostate cancer with extremely high PSA level: reconsidering the value of vintage therapy / 亚洲男科学杂志(英文版)

The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (<100 ng ml-1), intermediate (100-999 ng ml-1), and high (≥1000 ng ml-1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P < 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.

Efficacy of Autologous Blood Donation for Urologic Surgery in Kumagaya General Hospital / 日本農村医学会雑誌

From April 1993 to July 1996, the records of 119 patients (mean age: 69) undergoing urologic surgeries were analyzed to evaluate the influence and efficacy of autologous blood transfusion. The mean total blood volume (TBV) and collected blood volume of these patients were 4, 110 ml and 687.9 ml. The levels of hemoglobin decreased gradually after blood collection. However, they never fell below 10 g/dl. It appears that the use of r-EPO allows the collection of a sufficient volume of autologous blood without the occurrence of anemia associated with phlebotomy.<BR>Allogenic blood transfusion was dupensed with 68% for patients who underwent radical prostatectomy or total cystectomy, and 100% for those who underwent retropubic prostatectomy or transurethral resection of the prostate (TUR-P).<BR>We concluded that autologous blood transfusion is significantly effective for patients undergoing surgeries of benign prostatic hypertrophy, while there is room for further reduction in allogenic blood exposure in patients for surgery of malignancy.