Prospective study on the relationship between clinical efficacy of secondary hormone therapy with flutamide and neuroendocrine differentiation in patients with relapsed prostate cancer after first line hormone therapy. (October 2014)

• Record Type: Journal Article
• Authors: Hirano, Daisaku; Hasegawa, Ryo; Satoh, Katsuhiko; Mochida, Junichi; Yamanaka, Yataroh; Hirakata, Hitoshi; Yamaguchi, Kenya; Sugimoto, Shuji; Kawata, Nozomu; Takahashi, Satoru
• Is Part Of: Scandinavian journal of urology. Volume 48:Number 5(2014)
• Page Start: 436
• Page End: 444
• Publication Date: 2014-10
• Subjects: Urology -- Periodicals; 616.6
• DOI: 10.3109/21681805.2014.905633
• Languages: English
• ISSNs: 2168-1805

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective.</italic> The aim of this study was to prospectively verify the relationship between the clinical efficacies of secondary hormone therapy for castration-resistant prostate cancer (CRPC) following first line hormone therapy and neuroendocrine differentiation (NED). <italic>Material and methods.</italic> Forty-six consecutive patients with CRPC following first line hormone therapy who were treated with flutamide as secondary hormone therapy were prospectively assessed with a median follow-up of 21 months. Serum chromogranin A (CgA), as a marker of NED, was measured using an immunoradiometric assay. <italic>Results.</italic> Of the 46 patients, 22 (48%) responded to the secondary hormone therapy as a 50% or more reduction from baseline prostate-specific antigen (PSA) with a median response duration of 9.2 months. The PSA response group was correlated with significantly favorable cancer-specific survival (CSS) (92% vs 59% at 5 years, <italic>p</italic> = 0.0146) compared with the non-response group. Above-normal CgA levels at study entry were detected in 15 patients (33%), but no association with CSS was identified. Data on CgA kinetics were available in 35 patients. The CgA levels before and at 3 months during the treatment were similar. However, eight patients (23%) with an increase in CgA level of a quarter or more from baseline had a tendency for worse CSS (63% vs 84% at 5 years, <italic>p</italic> = 0.0507) compared with the remaining patients. <italic>Conclusion.</italic> Within limitations, in this study secondary hormone therapy with flutamide was effective for CRPC following first line hormone therapy. The above-normal CgA level in the first hormone resistance phase is mostly unrelated to prognosis. However, some patients with a remarkable increase in CgA in a short duration may have an unfavorable prognosis caused by NED as well.</p> </abstract>