ANTI-ANDROGEN THERAPY OF PROSTATIC CANCER AND REACTIVATION

Abstract

One hundred and fifty-two patients first treated at Department of Urology, Chiba University School of Medicine from June 1960 to December 1977 were followed, and the following results were obtained.
1) The actuarial 5-year and 10-year survival rates of all cases were 40% and 12%, respectively. When classified according to the degree of advancement, 5-year survival rates of stage A, B, C and D were 67%, 70%, 43% and 28%, respectively. Ten-year survival rates of each stage, on the other hand, were 67%, 46%, 11% and 0%, respectively.
2) Eighty-two patients had received anti-androgenic therapy as an initial therapy. The actuarial 5-year survival rates were 56% in stage C and 34% in stage D, thus indicating a slightly better prognosis than the entire group.
3) Those who were treated with anti-androgenic drugs were divided into the sufficient-dose and insufficient-dose groups, and the actuarial survival rates were examined. Five-year survival rates of the former group were 64% in stage C and 47% in stage D. Those of the latter group were 31% and 22%, respectively. The prognosis proved better in the sufficient-dose group.
4) Of the 152 cases, 103 were found dead. The advance of cancer was the commonest cause of death, accounting for 57%, while cardiovascular disturbances accounted for only 15%. In patients who had received anti-androgenic drugs, 53 cases were dead. Fifty-seven % of the death were caused by the advance of cancer, while 13% by cardiovascular disturbances. These figures are similar to those of the whole cases.
5) Reactivation was seen in 41 cases; the interval between the start of treatment and reactivation was 39.7±7.0 months for the stage C and 27.4±3.6 months for the stage D, and the difference between the two groups was significant. The interval between the reactivation and death was 11.2±2.3 months and 9.9±1.7 months, respectively. The difference was statistically insignificant. Reactivation took place in the form of local aggravation in 15 cases, occurrence or aggravation of metastasis to bones, or reincrease of once decreased acid phosphatase in 22 cases, and both in 4 cases.
6) Non-reactivated patients whose cancer had been suppressed for more than 2 years were compared with the group of reactivation. The group of reactivation was predominated by cases showing abnormal erythrocyte sedimentation rate or hydronephrosis at the first consultation. No difference was seen with castration or depending on the rates of hormone administration.
7) Of the reactivated cases, the sufficient-dose group was found rather delayed in development of reactivation as compared with the insufficient-dose group. But no difference was seen in the length of time between reactivation and death.
8) Radiation was found effective for local reactivation, but there were no good measures against reactivation extending to bones.