Incidence and characteristics of antiandrogen withdrawal syndrome in prostate cancer after treatment with chlormadinone acetates

被引:15
作者
Akakura, K [1 ]
Akimoto, S [1 ]
Furuya, Y [1 ]
Ito, H [1 ]
机构
[1] Chiba Univ, Sch Med, Dept Urol, Chuo Ku, Chiba 260, Japan
关键词
prostatic neoplasms; antiandrogen withdrawal syndrome; endocrine therapy; antiandrogens; prostate-specific antigen; chlormadinone acetate;
D O I
10.1159/000019657
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives: In patients with progressive prostate cancer who have been treated with surgical or medical castration plus an antiandrogen, antiandrogen withdrawal can result in a significant decline in serum prostate-specific antigen (PSA). Although the incidence of antiandrogen withdrawal syndrome after combination treatment with the nonsteroidal antiandrogen flutamide has been thoroughly documented, the phenomenon clearly occurs in many other combination therapies and is presently being widely investigated. This paper would like to contribute to this effort by describing the endocrine withdrawal phenomenon in patients treated with combinations of castration plus chlormadinone acetate, ethynylestradiol or estramustine phosphate. Materials and Methods: Clinical records of 68 prostate cancer patients who had been treated with surgical castration plus the administration of chlormadinone acetate, ethynylestradiol or estramustine phosphate, and who had shown clinical progression associated with a steady increase in serum PSA, were investigated. Forty-one cases were evaluable for changes in PSA after discontinuation of the hormonal agents. Results: Of 28 patients who had been treated with chlormadinone acetate, 12 (42.9%) revealed 50% or more decline in PSA level following withdrawal of the agent. Among these, 5 cases (17.9%) showed subjective and/or objective improvements. There was no significant difference in histological grade of the tumor at diagnosis, mode of progression, time interval from the start of endocrine therapy to discontinuation of the hormonal agents, or PSA levels at withdrawal of the agents between patients who did develop antiandrogen withdrawal syndrome and those who did not. Conclusion: When a steady increase in serum PSA is noted in a prostate cancer patient who has been treated with castration plus a steroidal antiandrogen, discontinuation of the antiandrogen may benefit the patient.
引用
收藏
页码:567 / 571
页数:5
相关论文
共 25 条
[1]  
AKAKURA K, 1995, UROLOGY, V45, P700, DOI 10.1016/S0090-4295(99)80070-3
[2]   TAMOXIFEN WITHDRAWAL RESPONSE - REPORT OF A CASE [J].
BELANI, CP ;
PEARL, P ;
WHITLEY, NO ;
AISNER, J .
ARCHIVES OF INTERNAL MEDICINE, 1989, 149 (02) :449-450
[3]   COMPLETE REMISSION OF HORMONE-REFRACTORY ADENOCARCINOMA OF THE PROSTATE IN RESPONSE TO WITHDRAWAL OF DIETHYLSTILBESTROL [J].
BISSADA, NK ;
KACZMAREK, AT .
JOURNAL OF UROLOGY, 1995, 153 (06) :1944-1945
[4]   MUTANT ANDROGEN RECEPTOR DETECTED IN AN ADVANCED-STAGE PROSTATIC-CARCINOMA IS ACTIVATED BY ADRENAL ANDROGENS AND PROGESTERONE [J].
CULIG, Z ;
HOBISCH, A ;
CRONAUER, MV ;
CATO, ACB ;
HITTMAIR, A ;
RADMAYR, C ;
EBERLE, J ;
BARTSCH, G ;
KLOCKER, H .
MOLECULAR ENDOCRINOLOGY, 1993, 7 (12) :1541-1550
[5]   DRAMATIC PROSTATE-SPECIFIC ANTIGEN DECREASE IN RESPONSE TO DISCONTINUATION OF MEGESTROL-ACETATE IN ADVANCED PROSTATE-CANCER - EXPANSION OF THE ANTIANDROGEN WITHDRAWAL SYNDROME [J].
DAWSON, NA ;
MCLEOD, DG .
JOURNAL OF UROLOGY, 1995, 153 (06) :1946-1947
[6]   RESPONSE TO FLUTAMIDE WITHDRAWAL IN ADVANCED PROSTATE-CANCER IN PROGRESSION UNDER COMBINATION THERAPY [J].
DUPONT, A ;
GOMEZ, JL ;
CUSAN, L ;
KOUTSILIERIS, M ;
LABRIE, F .
JOURNAL OF UROLOGY, 1993, 150 (03) :908-913
[7]   SURAMIN, AN ACTIVE-DRUG FOR PROSTATE-CANCER - INTERIM OBSERVATIONS IN A PHASE-I TRIAL [J].
EISENBERGER, MA ;
REYNO, LM ;
JODRELL, DI ;
SINIBALDI, VJ ;
TKACZUK, KH ;
SRIDHARA, R ;
ZUHOWSKI, EG ;
LOWITT, MH ;
JACOBS, SC ;
EGORIN, MJ .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1993, 85 (08) :611-621
[8]  
GADDIPATI JP, 1994, CANCER RES, V54, P2861
[9]  
GLEASON DONALD F., 1966, CANCER CHEMO THERAP REP, V50, P125
[10]   A THERAPEUTIC WITHDRAWAL CAN MAKE A STRATEGIC ADVANCE [J].
JORDAN, VC .
ANNALS OF ONCOLOGY, 1992, 3 (08) :587-588