Effect of prednisone on prostate-specific antigen in patients with hormone-refractory prostate cancer.
OBJECTIVE
To evaluate the effects of prednisone on prostate-specific antigen (PSA) in a cohort of patients with "hormone-refractory" prostate cancer.


METHODS
Data were collected from 29 consecutive patients with hormone-refractory progressive prostate cancer who were treated with 10 mg of prednisone orally two times a day. Patients were included in this analysis only if other factors known to influence PSA levels (antiandrogen withdrawal, radiation, and/or other concomitant anticancer therapies) were definitively excluded as potentially confounding variables.


RESULTS
The mean and median PSA decline after initiating prednisone was 33% (95% confidence interval [CI] 20% to 46%) and 24% (range 0% to 99%), respectively. Ten patients (34%) had a PSA decline of more than 50% and 4 patients (14%) had PSA declines of more than 75%. The average and median time for progression-free survivals were 2.8 (95% CI 1.7 to 3.8) and 2.0 (range 0 to 11) months. Four (14%) patients had PSA declines lasting 6 months or more. Median survival was 12.8 months. Additional analyses indicated that a PSA decline of more than 50%, compared with less than 50%, was associated with a longer survival. Toxicities included steroid myopathy (n = 4), new-onset diabetes (n = 1), and dyspnea (n = 1).


CONCLUSIONS
Prednisone (10 mg orally two times a day) can decrease PSA by more than 50% in approximately one third of patients with hormone-refractory progressive prostate cancer. On the basis of comparisons with other data sets, we hypothesize a dose-response relationship between glucocorticoid dose and PSA decline.
Department of Urology, Louisiana State University Medical Center, Shreveport, USA.
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Sartor
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Weinberger
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Moore
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Li
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D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology*; D018450:Disease Progression; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011241:Prednisone / Q000494:pharmacology*; D017430:Prostate-Specific Antigen / Q000187:drug effects*; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D017211:Treatment Failure
D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen; D011241:Prednisone