[Antiandrogen withdrawal syndrome in the hormonal treatment of metastatic prostatic cancer in hormonal escape].
A fall in the PSA level after stopping antiandrogens has been described at the stage of hormonal escape of prostatic cancer treated by complete androgen inhibition. The authors report a new case. The patient was offtially treated by pulpectomy and nitulamide for N+ prostatic carcinoma (PSA: 165 ng/ml). At the stage of hormonal escape, discontinuation of nitulamide induced a reduction of the PSA. Replacement of nitulamide by cytoproterone acetate was followed by a renewed increase of PSA, which again decreased after stomming cyproterone acetate. Three years later, the PSDA level was 3.5 ng/mg. This syndrome is probably due to mutation of the androgen receptor. In hormonal escape, suspension of all antiandrogens apart from LHRH analogues is recommended and can be followed by a temporary fall of PSA. No other antiandrogen must be administered in the place of the previous drug.
Barthélémy
Y
Y
Service d'Urologie, Hôpital Henri Mondor, Créteil.
Colombel
M
M
Gasman
D
D
Patard
J J
JJ
Chopin
D
D
Abbou
C C
CC
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000276:immunology; D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D003534:Cyproterone / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D048289:Imidazolidines; D008207:Lymphatic Metastasis; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000276:immunology; D013375:Substance Withdrawal Syndrome / Q000209:etiology*
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007093:Imidazoles; D048289:Imidazolidines; C021277:nilutamide; D003534:Cyproterone; D017430:Prostate-Specific Antigen