Advanced Prostate Cancer Cases Research Articles

PROSTATE SPECIFIC ANTIGEN AND PROSTATE ACID PHOSPHATASE DECLINES AFTER ESTRAMUSTINE PHOSPHATE WITHDRAWAL: A CASE REPORT

We report a case of advanced prostate cancer in which an initial response to hormonal therapy with surgical castration and estramustine phosphate (EMP) was followed by disease progression, as shown by sequential elevations in serum prostate specific antigen (PSA) and prostate acid phosphatase (PAP) and the development of new symptoms, during maintenance endocrine and anti-cancer chemotherapy. Discontinuation of EMP resulted in sustained reductions in serum PSA and PAP levels and a sustained improvement in symptoms.

Total Androgen Ablation: European Experience

Zoladex plus flutamide significantly delays the time to progression (subjective, objective, first progression) compared with orchiectomy, but no difference in survival (death from all causes or from malignant disease) could be detected. Thus, a delay in the appearance of progression has not improved survival. In fact, the duration of survival after progression tends to be shorter on Zoladex plus flutamide. There is thus no evidence to suggest any survival benefit with Zoladex plus flutamide. The quality control of our data revealed acknowledged problems in defining responses in patients with advanced prostate cancer. The review of the Bone Scan Committee provided the data for Tables 5 to 7. These data must provoke some reflections and emphasize once again the heterogeneity of the studied patient population. Table 4 on pain response after 4 weeks is just one of the many items to be analyzed by the committees for response criteria and quality of life. We expect that the other trials face similar problems. More work and patience are needed to obtain a firm answer to this clinical problem. These efforts will never be wasted, however, because the combined results of these trials will increase our knowledge of the treated history of prostate cancer and will, we hope, indicate a net treatment benefit in some subsets of patients. An individually tailored treatment for each patient selected from the anonymous mass of cases of advanced prostate cancer would be the highest reward of our continued collaboration with all the study groups.

進行性前立腺癌新鮮例に対する内分泌化学療法

From November 1981 to November 1987, 35 patients with newly diagnosed advanced prostatic cancer (6 Stage C cases and 29 Stage D2 cases) were treated by chemoendocrine therapy consisting of orchiectomy, diethylstilbestrol-diphosphate and cisplatin. Objective responses were assessed at 3 months after the start of treatment. Of the 35 patients, 8 had PR (partial response) and 27 was objective stable by NPCP criteria. Objective progression was not seen. In analysis of long-term results, the 3-year and 5-year survival rate for total cases were 75.8% and 60.7%, respectively. For Stage C cases, the 3-year and 5-year survival rates were 100% and 100%; for Stage D2 cases, they were 72.2% and 54.2%, respectively. Relapse was seen in 7 (24.1%) of the 29 Stage D2 cases. All of these 7 patients had poorly differentiated adenocarcinoma and most of them had more than 10 bone metastases. As for side-effects, gastroenteric symptoms (nausea and vomiting), anemia and slight liver dysfunction were seen. These results suggest that the chemoendocrine therapy is an effective treatment in newly diagnosed cases of advanced prostatic cancer.

Nuclear magnetic resonance in advanced prostate cancer (stage D).

Nuclear Magnetic Resonance (NMR), a recently developed diagnostic method, has proved to be useful in the study of patients with prostatic disease. The authors report their experience with this technique in 10 cases of advanced prostate cancer (stage D) treated with LH-RH agonists (HOE 766-Buserelin). NMR provided information on the size of the prostate, the invasion of the vesical floor and seminal vesicles and the involvement of the pelvic and retroperitoneal nodes. It was also useful for ruling out metastases in the pelvis and spinal column, and showed an excellent correlation with the bone scan. In 2 untreated cases, NMR was sufficient by itself to diagnose metastatic prostate cancer. However, given the current lack of experience, it is not yet possible to draw conclusions concerning the superiority of this technique over other methods in the diagnosis and staging of prostatic carcinoma.

Therapy with orchiectomy or estrogens or both

Since its introduction in 1941 by Huggins and Hodges,²androgen-control therapy has been found effective initially in about 70% to 80% of cases of advanced prostatic cancer. Just why the remainder do not respond is unclear. The typical remission is characterized by prompt relief of bone pain and lessening of urinary-tract symptoms. Objective changes include dramatic regression in the primary prostatic growth and return of elevated serum acid phosphatase (SAP) levels to normal. Changes in bone metastases (usually osteoblastic) occur commonly, but are difficult to evaluate radiologically. The metastases may disappear entirely and be replaced by new bone. Osteolytic metastases are not seen as infrequently as in breast cancer; with healing, these also are replaced by new bone. Enlargement of inguinal, femoral, and intra-abdominal lymph nodes usually decreases perceptibly, sometimes completely. Changes in serum alkaline phosphatase levels are not consistent. In many cases, the serum alkaline phosphatase level rises

Therapy With Orchiectomy or Estrogens or Both

Since its introduction in 1941 by Huggins and Hodges,²androgen-control therapy has been found effective initially in about 70% to 80% of cases of advanced prostatic cancer. Just why the remainder do not respond is unclear. The typical remission is characterized by prompt relief of bone pain and lessening of urinary-tract symptoms. Objective changes include dramatic regression in the primary prostatic growth and return of elevated serum acid phosphatase (SAP) levels to normal. Changes in bone metastases (usually osteoblastic) occur commonly, but are difficult to evaluate radiologically. The metastases may disappear entirely and be replaced by new bone. Osteolytic metastases are not seen as infrequently as in breast cancer; with healing, these also are replaced by new bone. Enlargement of inguinal, femoral, and intra-abdominal lymph nodes usually decreases perceptibly, sometimes completely. Changes in serum alkaline phosphatase levels are not consistent. In many cases, the serum alkaline phosphatase level rises