達文西攝護腺根除術後之攝護腺癌病人術後攝護腺指數上升早期使用Dutasteride治療之臨床分析
呂謹亨1、歐彥泉1、黃立華1、翁瑋 駿1、張佑剛2、陳鴻霖2、許兆畬1、童敏哲1
1童綜合醫院 外科部 泌尿科，2醫學研究部
Early dutasteride monotherapy in men with elevated serum prostate-specific antigen levels following robot-assisted radical prostatectomy
Chin-Heng Lu1, Yen-Chuan Ou1, Li-Hua Huang1, Wei-Chun Weng1, Yu-Kang Chang2, Hung-Lin Chen2, Chao-Yu Hsu1, Min-Che Tung1
1Divisions of Urology, Department of Surgery, 2Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
Background: To evaluate the efficacy of early dutasteride administration in patients with a detectable prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy (RARP).
Methods: We retrospectively analyzed RARP patients whose pathological stage is T2a to T3b without lymph node or distant metastasis from 2007 to 2017. All patients received dutasteride 0.5 mg daily when post-RARP PSA levels were increasing but had not achieved biochemical recurrence. PSA levels were monitored every 3 months after dutasteride administration. None of patients received radiotherapy (RT) or androgen-deprivation therapy (ADT) before taking dutasteride. All follow-ups were begun from RARP to January 2019 or to the date of RT/ADT.
Results: Thirty-five patients were enrolled in this study. The median followed up was 53.6 months. Twenty-two patients (62.9%) showed a PSA response in which the PSA decreased more than 10% at the first follow-up after dutasteride administration. These Pathological stage > T2 (p=0.012) and positive surgical margin (p=0.046) were risk factors for a PSA response. Twenty-three out of 35 enrolled patients (65.7%) did not require further RT/ADT. The significant risk factor was the PSA level (p=0.011) at the beginning of dutasteride treatment. The cut-off value of the PSA level to avoid further RT/ADT was 0.195 ng/ml.
Conclusions: Early dutasteride administration showed a significant decline in PSA levels of patients with pathology stage > T2 and positive surgical margin. If dutasteride was provided before the PSA value increased to 0.195 ng/ml after RARP, it would reduce the probability of acquirement of RT/ADT.