Modern tedavi yöntemleriyle metastatik prostat kanserli hastaların seyri değişti mi?

Abstract

Amaç: Metastatik prostat kanserinde androjen deprivasyon tedavisi standart tedavi yöntemidir. Mevcut tedavi yöntemlerine rağmen hastalık kısa sürede hormona dirençli hale gelmektedir. Biz bu çalışmamızda metastatik prostat kanser tanısı konulan hastalarda modern tedavi yöntemlerinin klinik seyir ve sağkalım üzerine etkilerini araştırdık.Gereç ve Yöntemler: Polikliniğimize 20052012 yılları arasında metastatik prostat kanseri tanısıyla başvuran ve tarafımızca takip edilen 118 hasta retrospektif olarak incelendi. Çalışmamızdaki hastaların klinik özellikleri, aldıkları hormonal tedavi yöntemleri, hastalığı ve tedaviye bağlı komplikasyonlar, hastalığın progresyonu ve sağkalım süresi kaydedildi.Bulgular: Hastaların tanı esnasındaki ortalama yaşları 69,4, biyopsi öncesi PSA değeri ortalama 255,1 ng/ml ve ortalama Gleason skorları 8,1 idi. Hormonal tedavi alan hastalarda hormona direnç gelişim zamanı ortalama 22,8 ±10,9 ay olarak hesaplandı. Hormona Dirençli Prostat Kanseri HDPK grubundaki hastalarının ortalama sağkalımı 13,7 ay olarak hesaplandı. Metastatik prostat kanseri tanısı konulan hastaların ölümüne kadar geçen süre ortalama 36,6±14,8 ay olarak saptandı. Hormonal tedavi olarak monoterapi LHRH analoğu veya orşiektomi alan grup ile maksimal androjen blokajı orşiektomi veya LHRH analoğu + antiandrojen alan grup karşılaştırıldığında ortalama sağkalım açısından anlamlı bir fark saptanmadı 35.7±12 ay – 37.2±16.4 ay, P=0.59 . Aralıklı hormonal tedavi alan grupla devamlı hormonal tedavi alan grubun karşılaştırılmasında sağ kalım açısından istatistiksel olarak anlamlı fark saptanmadı 38±12.1 ay − 35.5±16.7 ay, P=0.35 . Kemoterapi alan hastalarda ise ortalama sağkalım 7,4 ay olarak saptandı.Sonuç: Metastatik prostat kanseri, hem hastalığın kendisi hem de verilen tedavinin yan etkileri düşünüldüğü zaman dikkatli bir şekilde destek tedavisi gerektiren bir hastalıktır. Metastatik prostat kanseri hormona duyarlı bir tümör olmasına rağmen, aralıklı veya devamlı hormonal tedavi, monoterapi veya maksimal androjen blokajı tiplerinden hangisi verilirse verilsin sağkalım üzerinde ciddi bir fark yaratan etki görülmemektedir

Keywords

• Metastatik prostat kanseri,hormonal tedavi,sağkalım

Did the course of the metastatic prostate cancer patients change with modern treatment methods?

Abstract

Objectives: Androgen deprivation therapy is the standard treatment for metastatic prostate cancer. Although the current treatment methods the disease becomes hormone resistant after a while. In our study, patients diagnosed with metastatic prostate cancer, we investigated the effects of modern treatment methods in terms of the clinical course and survival. Materials and Methods: Between 2005- 2012, 118 patients followed at our outpatient clinic with diagnosis of metastatic prostate cancer were retrospectively analyzed. Clinical characteristics, hormonal treatment modalities of patients, disease and treatment-related complications, disease progression and survival time were recorded. Results: The mean age of the patients at diagnosis was 69.4 53-87 years, mean PSA level before biopsy was 255.1 20-2000 ng / ml and the mean Gleason score was 8.1 7-10 . The mean hormone resistance development time in patients receiving hormonal therapy was 22.8 ± 10.9 months. The mean survival of patients with hormone resistant prostate cancer HRPC was 13.7 3-19 months. The mean time between the diagnose and death in metastatic prostate cancer patients was 36.6 ± 14.8 months. There was no statistical difference between neither monotherapy group LHRH therapy or orchidectomy and maximal androgen deprivation therapy group orchidectomy or LHRH therapy with antiandrogen drugs 35.7±12 months – 37.2±16.4 months, P=0.59 nor the intermittent hormonal therapy patients and continuous hormonal therapy given group 38±12.1 months - 35.5±16.7 months, P=0.35 in terms of mean survival rates. In patients receiving chemotherapy, the median survival was 7.4 months. Conclusion: Metastatic prostate cancer, when considering the disease itself as well as the side effects of treatment is a disease that requires careful treatment with the supportive therapy. Although metastatic prostate cancer is a hormone-sensitive tumor, intermittent or continuous hormonal therapy, MAB or monotherapy any of them are given, there are no differences in terms of survival.

Keywords

• Metastatic prostate cancer,hormonal therapy,survival

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