ACTA ENDOCRINOLOGICA (BUC)

Introduction. Prostate specific antigen (PSA) progression is considered to be the earliest evidence of persistent or recurrent disease after primary therapy with curative intent in prostate cancer. The purpose of the study was to evaluate the predictive value of PSA progression under anti-androgen treatment in patients with advanced disease treated by bilateral orchidectomy alone or associated with antiandrogens.\r\nPatients and methods. We studied 87 patients diagnosed with prostate cancer between January 1998 and October 2005 with PSA values over 20 ng/ml. Prostate cancer was confirmed by transrectal ultrasound guided prostate biopsy. In all patients, prostatectomy was not performed, but bilateral orchidectomy. Flutamide 750 mg three times daily was associated from the beginning with surgical castration in patients with bone metastases (n=11). In the other patients, Flutamide 750 mg three times daily was started if a progression of the disease was noted, 29 out of 76 cases. The follow-up protocol included physical examination and digital rectal examination, acid and alkaline phosphatases and seric PSA every 3 months in the first two years and then every 6 months.\r\nResults. Patients were divided after orchidectomy and after 6 months of flutamide therapy in four groups: Group 1 (n= 46 cases) with PSA response, i. e. decrease at less than 1 ng/ml, Group 2 (n= 22 cases) with PSA decrease to 1 - 4 ng/ml, Group 3 (n= 11 cases) PSA response between 4 and 10 ng/ml and Group 4 (n= 8 cases), with PSA serum levels over 10 ng/ml PSA serum levels increased progression occurred in 12, 10, 8 and 8 patients of the four groups, respectively, and disease clinical progression was observed in 7, 7, 6 and 7 patients, respectively. Mean intervals of PSA progression in the four groups were 52, 36, 32 and 11 months, respectively. An important complication rate was observed, represented by acute urinary retention, unilateral ureterohydronephrosis, obstructive anuria, pulmonary and bone metastases, chronic renal failure and hematuria by bladder invasion.\r\nConclusions. Our study confirmed the data from the literature that serum PSA level could be used as an surveillance marker in patients with advanced prostate cancer submitted to orchidectomy with or without anti-androgen receptor therapy and also has an important prognostic value.