使用雄性素去除療法加上Abiraterone及類固醇治療新診斷去勢敏感性攝護腺癌之初期經驗
林宜佳1,2 、蔡德甫1,2、朱懿柏1、葉志胤1、吳子翔1、何肇晏1、陳宏恩1、仇光宇1,2、鄭以弘1、葉忠信1,2、莊光達1,2、黃一勝1,2
1新光醫院 外科部 泌尿科、2輔仁大學 醫學系
Preliminary Experience on Combination of Androgen Deprivation Therapy and Abiraterone Acetate plus Prednisolone in Patients with De Novel Metastatic Castration Sensitive Prostate Cancer
Yi-Chia Lin1,2, Te-Fu Tsai1,2, Yi-Bo Chu1, Chi-Yin Yeh1, Tze-Shiang Wu1, Chao-Yen Ho1, Hung-En Chen1, Kuang-Yu Chou1,2, Yi-Hong Cheng1, Chung-Hsin Yeh1,2, Guang-Dar Juang1,2 and Thomas I-Sheng Hwang1,2
Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital1, School of Medicine, Fu-Jen Catholic University 2, Taipei, Taiwan.
 
Background: 
Androgen deprivation therapy (ADT) has been proved to be the backbone of treatment for advanced prostate cancer. However, recent evidences showed add-on therapies such as docetaxel chemotherapy or second-line hormonal manipulation improve overall survival for patients with metastatic castration sensitive prostate cancer (mCSPC). W report our preliminary experience on the combination of ADT and abiraterone acetate plus prednisolone.
Materials and methods: 
From January, 2018 to June, 2019, 6 patients with a diagnosis of de novo mCSPC were treated with upfront ADT with abiraterone acetate plus prednisolone. All patients were categorized as high-risk mCSPC according to the criteria of LATITUDE trial. The initial dose of abiraterone was 1000 mg with 5 mg prednisone once a day. The treatment started within a month after diagnosis. Dosing schedules were subjected to change to a lower dose according to the side effects and financial condition of the patients. The oncological outcomes were evaluated by collecting the response of symptoms, prostate specific antigen (PSA) level and image studies including bone scan and computed tomography (CT) scan. Dihydroepiandrsterone sulfate (DHEA-S) level was also recorded in these patients.
Results: 
The median age was 75 (59-88) years old. The initial median PSA level was 542.5 (42-1500) ng/dl. The ISUP grade was 3 in 1 patient, 4 in 2 patients and 5 in 3 patients. All of the patients have more than 4 bony metastasis and 4 patients have lymph node metastasis. All patients received a LHRH analogue as ADT. Three patient were present with symptoms including 2 bone pain and 1 gross hematuria with acute urinary retention. The PSA response in the third month was 5.0 (0.75-16.6) ng/dl and in the 6th month was 0.23 (0.04-5.4) ng/dl. All 3 patients had symptom relief before the 3rd month. Image studies at the 6th month showed regression of the bony metastasis and lymph node metastasis. The median DHEA-S level was 3.6 (2.1-13) ng/dl in the 6th month. All patient have a dosing schedule change from the 3rd to 6th month including 1 patient with side effect and 5 patients with financial concerns. The median follow-up was 16 (9-27) months.
Conclusion: 
ADT combined with abiraterone acetate plus prednisolone are effective and well-tolerated in patients with mCSPC. The decline of PSA was prominent and the relief of symptoms was fast. The preliminary outcome of the combination is promising and more data should be collected to verify the effect of this treatment in Taiwanese patients.
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    TUA人資客服組
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    台灣泌尿科醫學會
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    2020-06-11 15:22:39
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    2020-06-11 15:23:02
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