前立腺癌に関する研究 1.抗男性ホルモン療法の効果と予後に関する検討

Abstract

Seventy patients with carcinoma of the prostate were treated at the Department of Urology, Hiroshima University Hospital during the 10 years period, 1967 to 1976. 1) The average age of the patients was 71.5 years. Most of them had complaint of difficulty onurination. Pain due to metastasis to the bone was seen in 21.4%. Cardiovascular disease was accompanied in 24.6%. 2) Intravenous pyelograms were abnormal in 20.7% already before the treatment. 3) Total serum acid phosphatase was elavated in 9.3% of stage C cases and 74.2% of stage D cases. Prostatic serum acid phosphatase was elevated in 17.9% of stage C and 62.1 % of stage D. Total serum acid phosphatase was elevated in 68.0% of the cases with meatstasis to the bone and in 16.7% of the cases without it. Prostatic serum acid phosphatase was elevated in 65.2% and 20.5%, respectively. 4) The clinical response was seen in 68.4% of the cases treated by antiandrogenic methods. 5) Relative survival rate of seventy cases at five and eight years was 0.562 (±0.073) and 0.190 (±0.055). Relative survival rate at five years of the stage C and D group was 0.750 (±0.014) and 0.283 (±0.093), respectively. Relative survival rate at 8 years showed no difference between two groups. 6) Cases with bladder infiltration had shorter survival than those without it, but these differences were not significant. Survival rate was not related with abnormalities on IVP and with the endoscopic findings. 7) Relative survival rate at five years showed significant difference between the cases with and without bone metastasis. 8) The relative survival rate was better, the higher the age at the first hospital visit. 9) The cases which showed elevated total or prostatic serum acid phosphatase showed slight tendency of poor survival. The cases in which those phosphatases remained high despite estrogen therapy showed extremely poor survival. 10) The period required for progression from stage C to stage D was clinically 38.4 (±6.4) months. 11) Forty cases were clear in ferms of causes of death. Twenty-four (60.0%) of them died of cancer of the prostate. The causes other than cancer increased with aging of the patients. 12) Death due to cardiovascular disease was not experienced even among the patients receiving high rate of estrogen. 13) The cases receiving high rate of estrogen showed low recurrence rate at two years. Period from the recurrence to death was relatively long in these cases. In stage C group, those treated with high rate of estrogen showed longer period to the recurrence and death. In stage D group, this was not remarkable. 14) At the time of recurrence of carcinoma of the prostate, total serum acid phosphatase was abnormally high in 14 (73.7%) of 19. Administration rate of estrogen did not affect the serum acid phosphatase level at the time of recurrence.