title: Significant prostate-specific antigen (PSA) response to low-dose ketoconazole in a patient with non-metastatic androgen-independent prostate cancer (AIPC) and a review of the literature.
abstract: Although there are a variety of treatment options for nonmetastatic androgen-independent prostate cancer (AIPC), they have limited benefits. Currently, no standard of care exists for this population. Ultimately, sequential therapeutics can be used to minimize symptomatic progression and control the underlying disease, as determined by prostate-specific antigen (PSA) levels. We report here a 90-year-old patient who had PSA progression after multiple previous treatments and was started on ketoconazole 200 mg, three times daily. His serum PSA levels dropped 84% in less than a year on therapy. A literature review yields several studies that support the benefits of ketoconazole as noted by PSA reduction and correlates these responses with survival benefits. The literature also suggests that low-dose ketoconazole may be an appropriate second- or third-line hormonal agent in AIPC, causing a PSA decline, symptomatic relief, and minimal toxicity.
authors.affiliation: Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-1750, USA. arlenp@mail.nih.gov
authors.forename: Ravi A
authors.initials: RA
authors.lastname: Madan
authors.forename: Ron
authors.initials: R
authors.lastname: Lieberman
authors.forename: James L
authors.initials: JL
authors.lastname: Gulley
authors.forename: William
authors.initials: W
authors.lastname: Dahut
authors.forename: Philip M
authors.initials: PM
authors.lastname: Arlen
mesh_terms: D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use*; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood / Q000187:drug effects*; D011471:Prostatic Neoplasms / Q000145:classification / Q000188:drug therapy*
chemical_list: D017430:Prostate-Specific Antigen; D007654:Ketoconazole