前立腺癌に対するLH-RH analogue投与直後の内分泌および腫瘍マーカーの動態について

Abstract

未治療前立腺癌症例8例に対してlong acting LH-RH analogueを使用した。1)一過性の血中テストステロン濃度の上昇は7例に認め, そのピークは6例では3日目, 1例では14日目であった。2)一過性の血中テストステロン濃度の上昇に起因する前立腺局所およびその随伴症状の悪化, すなわちflare-upはstage D2の2例に骨性疼痛の増悪を, 1例に排尿障害の悪化による尿閉状態を認めた。3)腫瘍マーカーである血中PAPは, LH-RH analogue投与前に異常値を認めた7例中4例において, また血中PSAは投与前に異常値を認めた7例中3例において, 投与後7日目まで微増し以後は低下するのを認めた

The dynamics of hormonal levels and tumor markers after the first administration of long-acting luteinizing hormone-releasing hormone (LH-RH) analogue were evaluated in patients with prostate cancer. Eight patients with histopathologically proved prostate cancer who were previously untreated were studied. The surge in plasma testosterone was recognized in 7 patients after the first administration of a long-acting LH-RH analogue, and reached the highest level after the 3rd day in 6 patients and 14th day in 1 patient. The onset of flare-up reaction due to a transient increase in plasma testosterone was recognized in 3 patients, whose clinical symptoms and signs were increased bone pain in 2 patients and acute urinary retention in 1 patient. An abnormal level of serum prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) was observed in 7 of the 8 patients before treatment. The serum PAP and PSA levels slightly increased after treatment in 4 and 3 patients, respectively. These findings suggest that the combination of estrogen or antiandrogen would allow a safer use of long-acting LH-RH analogue to prevent the risk of a flare-up reaction associated with the first administration of long-acting LH-RH analogue.