骨転移を伴った前立腺癌におけるAlkalinephosphataseflare現象の検討

Abstract

骨転移を有する前立腺癌において, 内分泌療法によりPSA値がPR以上の効果を示した症例におけるALP flare現象について検討した. 1)対象症例60例中flare群が13例, non-flare群が47例. 2)ALP flare群は有意にEOD gradeが高く(p=0.0352), PSAが高値であり(p=0.0010), ALP flare現象はより進行した症例に認められた. 3)ALP flare群は内分泌療法によりPSAが正常化しにくく(p=0.0211), 再燃迄の期間が短かった(p=0.0027).以上より, 骨転移を有し内分泌療法によりPSA値にPR以上の効果が認められた前立腺癌症例において, ALPのflare現象を認めた場合はなんらかの追加治療をprospectiveに考慮する必要がある

To clarify the roles of alkaline phosphatase (ALP) flare in prostate cancer accompanied by bone metastases and treated with hormonal therapy, we evaluated the clinicopathological character, treatment efficacy and outcome for patients with and without ALP flare. We evaluated 60 patients with newly diagnosed prostate cancer accompanied by bone metastases and treated with hormonal therapy, whose response in terms of serum prostate specific antigen (PSA) levels showed a partial response (PR) or better response. The patients were classified into two groups, an ALP flare group (13 cases) and a non-ALP flare group (47 cases). The former showed serum ALP elevation of more than double, and the latter less than double that of pretreatment levels following hormonal therapy. Patient characteristics, PSA response and outcome were compared between the two groups. Extent of disease (EOD) as grade of bone metastasis was significantly higher in the ALP flare group than in the non-flare group (p = 0.0352). Pre-treatment serum PSA levels were also significantly higher in the ALP flare group (p = 0.0010). However, there were no significant differences in pretreatment serum ALP levels. Serum PSA levels were normalized in 37 of the 47 patients (78.7%) in the non-ALP flare group compared with 6 of the 13 (46.2%) in the ALP flare group (p = 0.0211). Moreover, the period until biochemical failure was significantly shorter for the ALP flare than the non-flare group (p = 0.0027). These results suggest that prostate cancer patients with bone metastases in whom ALP flare is observed in response to hormonal therapy tend to have more extensive bone metastases, high pretreatment PSA levels, to be resistant to PSA normalization and more likely to experience biochemical failure.