Characterization of Patients with Androgen-Independent Prostatic Carcinoma Whose Serum Prostate Specific Antigen Decreased Following Flutamide Withdrawal

Abstract

No AccessJournal of UrologyClinical Urology: Original Article1 Feb 1996Characterization of Patients with Androgen-Independent Prostatic Carcinoma Whose Serum Prostate Specific Antigen Decreased Following Flutamide Withdrawal Juan Herrada, Pauline Dieringer, and Christopher J. Logothetis Juan HerradaJuan Herrada , Pauline DieringerPauline Dieringer , and Christopher J. LogothetisChristopher J. Logothetis View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66468-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We confirmed the reported rate of prostate specific antigen (PSA) suppression after flutamide withdrawal in patients with metastatic prostatic carcinoma, increasing serum PSA and tumor progression following treatment with total androgen blockade (castration and flutamide). The value of clinical variables in predicting the rate of PSA decrease after flutamide withdrawal was assessed and adrenal androgen metabolism was correlated with the rate of PSA suppression following flutamide withdrawal. Materials and Methods: A total of 41 consecutive patients with metastatic prostatic adenocarcinoma and an increasing serum PSA while effectively castrated (plasma testosterone level less than 50 ng./ml.) who were receiving 250 mg. flutamide 3 times daily was evaluated prospectively before cessation of the flutamide. Responses were determined at 6 weeks. Only 2 of the 41 study patients (3 percent) had stable disease at 6 weeks, that is they had not met objective criteria for response or progression at analysis. Results: Of 39 patients studied 11 (28.2 percent, 95 percent confidence interval 14 to 45 percent) had a PSA decrease (more than 50 percent from baseline) following flutamide withdrawal and they were treated with initial complete androgen blockade. Median duration of PSA decrease was only 13 weeks (range 7 to 52), and 3 of the 11 patients had continued suppression of serum PSA concentrations at 12+, 13+ and 20+ weeks. The serum PSA decrease was associated with improved clinical symptoms, although objective regression of the disease was found in only 1 to 2 patients with measurable disease. No statistical correlation between endocrine studies or serum bombesin secretion and PSA decrease was found, although patients with a PSA decrease after flutamide withdrawal tended to have a lower dehydroepiandrosterone concentration than those with PSA progression. No correlation between known prognostic variables and decreased serum PSA after flutamide withdrawal was detected. Conclusions: We confirmed the existence of the reported paradoxical PSA decrease in patients with androgen-independent carcinoma of the prostate, and that the delivery of simultaneous initial flutamide with castration predicts for PSA decrease. 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Anderson Cancer Center, Houston, Texas.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byARLEN P, GULLEY J, TODD N, LIEBERMAN R, STEINBERG S, MORIN S, BASTIAN A, MARTE J, TSANG K, BEETHAM P, GROSENBACH D, SCHLOM J and DAHUT W (2018) ANTIANDROGEN, VACCINE AND COMBINATION THERAPY IN PATIENTS WITH NONMETASTATIC HORMONE REFRACTORY PROSTATE CANCERJournal of Urology, VOL. 174, NO. 2, (539-546), Online publication date: 1-Aug-2005.Schellhammer P, Venner P, Haas G, Small E, Nieh P, Seabaugh D, Patterson A, Klein E, Wajsman Z, Furr B, Chen Y and Kolvenbag G (2018) Prostate Specific Antigen Decreases After Withdrawal of Antiandrogen Therapy with Bicalutamide or Flutamide in Patients Receiving Combined Androgen BlockadeJournal of Urology, VOL. 157, NO. 5, (1731-1735), Online publication date: 1-May-1997.Small E, Baron A, Fippin L and Apodaca D (2018) Ketoconazole Retains Activity in Advanced Prostate Cancer Patients with Progression Despite Flutamide WithdrawalJournal of Urology, VOL. 157, NO. 4, (1204-1207), Online publication date: 1-Apr-1997.Gomella L, Ismail M and Nathan F (2018) Antiandrogen Withdrawal Syndrome With NilutamideJournal of Urology, VOL. 157, NO. 4, (1366-1366), Online publication date: 1-Apr-1997. Volume 155Issue 2February 1996Page: 620-623 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Juan Herrada Recipient of 1994 American Society of Clinical Oncology Merit Award. More articles by this author Pauline Dieringer More articles by this author Christopher J. Logothetis More articles by this author Expand All Advertisement PDF downloadLoading ...