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

Yi-Chia Lin^1,2, Te-Fu Tsai^1,2, Yi-Bo Chu¹, Chi-Yin Yeh¹, Tze-Shiang Wu¹, Chao-Yen Ho¹, Hung-En Chen¹, Kuang-Yu Chou^1,2, Yi-Hong Cheng¹, Chung-Hsin Yeh^1,2, Guang-Dar Juang^1,2 and Thomas I-Sheng Hwang^1,2

Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital¹, School of Medicine, Fu-Jen Catholic University ², Taipei, Taiwan.

 

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.

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.

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 6^th month was 0.23 (0.04-5.4) ng/dl. All 3 patients had symptom relief before the 3^rd month. Image studies at the 6^th 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 6^th month. All patient have a dosing schedule change from the 3^rd to 6^th month including 1 patient with side effect and 5 patients with financial concerns. The median follow-up was 16 (9-27) months.

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.