title: Third-line hormonal therapy to treat prostate cancer relapse after initial and second-line hormonal therapy: report of 52 cases and literature review.
abstract: The aim of this study was to evaluate the efficacy of third-line combined androgen blockade (CAB) therapy for castration-resistant prostate cancer that relapsed after primary and second-line CAB. We retrospectively reviewed the medical records of 52 patients who received first-, second-, and third-line CAB therapy (medical or surgical castration, plus steroidal antiandrogen of chlormadinone acetate, or nonsteroidal antiandrogen of flutamide or bicalutamide). For cumulative analysis, we searched the PubMed database and identified a total of 50 cases published in English. Including our cases, this provided a total of 102 cases for analysis. In our study cohort, 11 cases (21.2%) achieved more than 50% reduction of serum prostate-specific antigen (PSA) on initiation of third-line CAB. We found that third-line CAB with nonsteroidal antiandrogen after second-line CAB with steroidal antiandrogen exhibited favorable results, with a positive response in six of 13 patients (46.2%). Cumulative analysis findings were comparable. Regarding the timing of third-line CAB administration, 15 patients had started at a PSA equal to or less than 4.0 ng/ml, and eight of them (53.3%) showed a positive response to treatment, compared to only three of 37 patients (8.1%) whose PSA at the initiation of third-line therapy was higher than 4.0 ng/ml (p<0.001). We conclude that third-line CAB with nonsteroidal antiandrogen would be particularly useful for patients whose cancer progressed after second-line CAB with steroidal antiandrogen. The timing of treatment seems to be important because the higher the PSA at the start of third-line therapy, the lower the PSA response rate.
authors.affiliation: Department of Urology, Tokyo Saiseikai Central Hospital, Mita, Minato-ku, Tokyo E-mail : kazz_matsumoto@yahoo.co.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Takahiro
authors.initials: T
authors.lastname: Maeda
authors.forename: Akiharu
authors.initials: A
authors.lastname: Ninomiya
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Nagata
authors.forename: So
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage; D000813:Anilides / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002715:Chlormadinone Acetate / Q000008:administration & dosage; D015331:Cohort Studies; D005485:Flutamide / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007610:Kallikreins; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009570:Nitriles / Q000008:administration & dosage; D017430:Prostate-Specific Antigen; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D012189:Retrospective Studies; D014105:Tosyl Compounds / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D000813:Anilides; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014105:Tosyl Compounds; D002715:Chlormadinone Acetate; D007987:Gonadotropin-Releasing Hormone; D005485:Flutamide; C053541:bicalutamide; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen