Clinical Evaluation of Advanced Prostate Cancer Treated with LH-RH Analogue
謝德生(Teh-Sheng Hsieh)；陳淳(Jun Chen)；蔡崇璋(Tsong-Chang Tsai)；陳奕文(Yi-Wen Chen)
buserelin ； hormone therapy ； prostate cancer
|Volume or Term/Year and Month of Publication||
2卷3期（1991 / 09 / 01）
531 - 535
傳統上，末期前列腺癌主要以雌激素來抑制癌細胞之生長，但其副作用非常大，尤其前列腺癌病患多為高齡，雌激素之心血管副作用，常有致命之危險。若以睪丸切除術做為內分泌療法，則對病人的心理傷害極大。因此，我們引用新的性激素分泌表(LH-RH)之同質物 buserelin於臨床研究，從1987年2月起，應用於13位D2 期前列腺癌病患，平均追蹤期為20.7個月，年齡為63至83歲。使用方法為前一週使用，cyproteron acetate，並持續使用五週，第二週起使用buserelin皮下注射一週，繼之以buserelin鼻噴劑持續治療。病人以臨床症狀、體動、活動力、肛診、血液生化學、血球計數、前最腺酸性磷酸酶、前列腺特異抗原、血中睪固酮、經直腸超音波、靜脈腎盂攝影、骨同位素掃及電腦斷層掃描來做追踨檢查及療效評估之依據。結果顯示，所有病人於治療後兩週血中睪固酮含量皆達到去勢之水準。臨床症狀方面38.5%病人有改善，23%病人持穩，38.5%病人症狀惡化。而在初治療一週間，並無因為短暫之睪固酮反彈升高而有病症惡化之現象。副作用方面，有2位病人主訴性無能，一位臉部泛紅。4位病人在治療期間死亡。生化及血球計數皆無變化。 因此，我們認為buserelin可用以代替睪丸切除來治療末期前列腺癌病患，使病人血中睪固酮含量達於去勢之水準，而少有其他內分泌療法之副作用。
Since traditional estrogen therapy for prostate cancer may cause dangerous cardiovascular side effects and orchievtomy has psychological impacts to the patients, we investigated the newly introduced LH-RH analogue to know the clinical effects and adverse reactions in this study. Thireteen patiens of advanced prostate cancer were treated with the LH-RH analogue, Buserelin ([D-Ser-Ser(t-Bu)]6-LH-RH nonapeptide ethylamide), since February 1987. Mean follow up period was 20.7 months, ranged from 5to 36 months. The age of patients were 63ti 83 year-old. Cyproterone acetate 50 mg thrice a day were given one week before Buserelin therapy, and continued for another 4 weeks. Buserelin was given with 500mcg subctuanecous in jevtion thric a day for one week and 200mcg nasal spray 6 times a day thereafter. The patients were followed up with clinical symptoms, body weight, physical status, rectal palpation, blood chemistry, hemogram, prostate acid phosphatase (PAP), prostate specific antigen(PSA) and hormone study every month , transrectal sonography of prostate , chest x-ray every 3 months, and intravenous pyelography, bone scan , CT scan every 6 months. Clinical response was evaluated with National Prostatic Cancer Project (NPCP) criteria. All Patients achieved castration level of testosterone in two weeks after Buserelin treatment, and maintaind the level thereafter. Five patients (38.5%) responsed to Buserelin therapy, three (23%) were stationary, and Five (38.5%) non-responsed clinically. There was no disease flare up during initiation of Buserelin therapy. Two patients complained of loss of libido and even impotence, and one had facial hot flashes. Four patients died during follow up period. One of them died of congested heart failure, and the other 3 patients were died of cancer metastasis. There is no specific change of liver funcion, renal function and hemogram before and after treament. Thus buserelin is a safe alternative hormone treatment of prostatic cancer to achieve castration level of testosterone without psychological distress.