針對賀爾蒙療法失敗之轉移性前列腺癌使用Abiraterone或者Docetaxel之後出現PSA flare現象之探討
劉惠瑛、沈元琦、尤政仁、江博暉
高雄長庚紀念醫院 泌尿科
PSA flare in Metastatic Castration-Resistant Prostate Cancer patients treated with Abiraterone or Docetaxel
Hui-Ying Liu, Yuan-Chi Shen, Cheng-Jen Yu, and Po-Hui Chiang
Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Purpose
The aim of this study was to assess PSA flare up phenomenon in the treatment of metastatic castration-resistant prostate cancer (mCRPC) patients with abiraterone or docetaxel and to correlate with clinical outcome.
Patients and Methods
We retrospectively evaluated 92 patients with metastatic castrate-resistant prostate cancer (CRPC) either treated with abiraterone or docetaxel at our institution. Baseline serum PSA levels were checked before treatment and followed by monitoring every 4 weeks in the group of abiraterone and every cycle in the group of docetaxel. The PSA flare phenomenon was evaluated. Clinical outcomes were evaluated to compare survival between groups of patients according to variations of PSA level.
Results
Of 92 patients, 73 patients received docetaxel therapy and 19 patients treated with abiraterone. They were classified into four groups: stabilization (PSA decline ＜50%), PSA progression, primary responder (PSA decline ≧ 50%), and flare-up phenomenon. Six patients (8.2%) got docetaxel therapy and two patients (10.5%) got abiraterone therapy were identified with PSA flare phenomenon. We compared the overall survival between group of PSA decline> 50% with the flare-up group. There was no statistical difference in survival between two groups.
Conclusion
There is a considerable portion of mCRPC patients experience PSA flare under either abiraterone or docetaxel therapy. There was no statistical difference in survival between PSA responder and PSA flare-up phenomenon group. Patients should be informed of this effect to avoid early, and thereby inadequate, discontinuation of treatment.