病期D2前立腺癌内分泌療法による前立腺性酸性ホスファターゼ,γ-セミノプロティンおよび前立腺特異抗原の変動と予後

Abstract

初回治療として内分泌療法を施行した病期D2前立腺癌120例について, PAP, γ-SmおよびPSA値と予後およびマーカー併用の有用性を検討した.1)治療前マーカー値の高低と予後とは, PAP, γ-SmおよびPSA共関連が認められなかった.2) PAPおよびγ-Smにおいては, 内分泌療法後3ヵ月および6ヵ月の時点で, マーカーが異常値にとどまるものの予後は正常化したものより不良であった.ただし, 1ヵ月後ではこの関連がみられなかった.3)内分泌療法後3ヵ月の時点で, PAPが正常化したもののうち癌死例があるが, これらの大多数はγ-Smは異常値にとどまっていた.したがって, 両マーカーの併用により, よりよく予後を推測できる.4)低分化腺癌で, 内分泌療法後3ヵ月でマーカー正常化の有無は予後に差があり, 正常化したものは中分化腺癌で異常値のままのものと同じ予後であった.このことにより, 組織学的分化度は経過を腫瘍マ, ーカーにて観察することでより有用となることを確認した

Prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostate specific antigen (PSA) were examined on 120 cases of stage D2 prostate cancer between 1979 and 1989. All patients received endocrine therapy as the first treatment; castration and immediate administration of estrogen or antiandrogen (101), LH-RH analogs (13), estrogen (3) and antiandrogen (3). The actuarial survival rates were calculated by the cause-specific survival method. Pretreatment levels of PAP, gamma-Sm and PSA did not influence prognosis. After start of treatment, the relationship between the changes of the markers and prognosis were examined. At 1 month after the start of the treatment, normalization of PAP or gamma-Sm was not reflected in the following course. On the contrary, at 3 and 6 months, groups with normalization of PAP or gamma-Sm showed better prognosis than those with elevated levels. The same tendency of PSA was obtained at 6 months after start of treatment. In patients with normalized PAP at 3 months, abnormal gamma-Sm showed worse prognosis than normalized gamma-Sm. Therefore, the significance of determination on the two markers was manifested. As histological grade influenced the following course, poorly differentiated adenocarcinoma with normalized PAP at 3 months showed better prognosis than those with elevated levels. In conclusion, it is worthwhile to measure multiple markers for predicting the prognosis of stage D2 prostate cancer treated with endocrine therapy.