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Prior administration of a non-steroidal anti-androgen failed to prevent the flare-up caused by a luteinizing hormone-releasing hormone agonist in a patient with metastatic prostate cancer.

Uehara S, Yuasa T, Fujii Y, Yano A, Yamamoto S, Masuda H, Fukui I, Yonese J - BMC Res Notes (2015)

Bottom Line: Then the serum level decreased again to less than 0.1 ng/mL.In this case, anti-androgen was probably not effective from the initial administration.Awareness of the possibility of ineffectiveness of anti-androgens is important in the treatment of symptomatic metastatic prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. sho.uehara@jfcr.or.jp.

ABSTRACT

Background: 'Flare phenomenon' after initial luteinizing hormone-releasing hormone agonist administration is a widely approved concept in the treatment of prostate cancer. In most guidelines, concomitant therapy with anti-androgens is recommended to prevent this flare phenomenon. However, there are few reports describing serum prostate-specific antigen transitions after hormonal therapy. Here, we present a case of a man who experienced the biochemical and clinical flare phenomenon despite prior anti-androgen use and who has detailed data.

Case presentation: A 70-year-old Asian man with metastatic prostate cancer (multiple bone) was referred to our hospital. He was treated with prior anti-androgens and luteinizing hormone-releasing hormone agonist. Regardless of prior use of anti-androgens, his low back pain caused by bone metastases was deteriorated and serum prostate-specific antigen level was raised from 974.8 ng/mL to 2,555.5 ng/mL within 3 weeks. Then, his serum prostate specific antigen level started to decrease along with the pain. The nadir reached 1.0 ng/mL and remained for 6 months. Because the serum level of prostate-specific antigen then began to increase again, anti-androgen was discontinued for anti-androgen withdrawal syndrome. Then the serum level decreased again to less than 0.1 ng/mL. Until now, his serum prostate-specific antigen level has been maintained at less than 0.1 ng/mL for more than 30 months without any clinical progressions.

Conclusion: We present the case of a patient in whom a clinical flare caused by an leuteinizing hormone-releasing hormone agonist was not prevented by prior anti-androgen administration. In addition, the nadir level of prostate-specific antigen when he received leuteinizing hormone-releasing hormone monotherapy was ten times lower than when he received concomitant therapy, and period of anti-androgen withdrawal syndrome was longer than usual. In this case, anti-androgen was probably not effective from the initial administration. Awareness of the possibility of ineffectiveness of anti-androgens is important in the treatment of symptomatic metastatic prostate cancer. Leuteinizing hormone-releasing hormone antagonist and surgical castration is a more reliable clinical approach for the prostate cancer patients with symptomatic metastatic disease.

No MeSH data available.


Related in: MedlinePlus

Imaging and the clinical schema of a symptomatic metastatic prostate cancer patient. a Initial bone scan images showing multiple bone metastases, which included the sacral bone (arrow). b Initial clinical schematic presentation with alteration of the serum prostate-specific antigen level. c Clinical schematic presentation of the whole process with alteration of the serum prostate-specific antigen level.
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Fig1: Imaging and the clinical schema of a symptomatic metastatic prostate cancer patient. a Initial bone scan images showing multiple bone metastases, which included the sacral bone (arrow). b Initial clinical schematic presentation with alteration of the serum prostate-specific antigen level. c Clinical schematic presentation of the whole process with alteration of the serum prostate-specific antigen level.

Mentions: A 70-year-old Asian man was referred to our hospital for treatment of prostate cancer. His serum prostate-specific antigen (PSA) level was 974.8 ng/mL and trans-perineal prostatic biopsy revealed prostate cancer, with a Gleason score 5 + 4. A whole-body bone scintigraphy demonstrated multiple bone metastases [extent of disease (EOD): 2] including the sacral bone (Fig. 1a). Magnetic resonance imaging (MRI) also indicated a metastasis at the same site, which was causing severe low back pain. The patient was hospitalized for pain control and started to undergo hormonal therapy. Prior administration of the non-steroidal anti-androgen, bicalutamide, was followed by injection of the LHRH-agonist, leuprorelin, after 1 week. However, severe back pain continued to increase with increased PSA serum level (Fig. 1b). One week after bicalutamide administration, serum PSA level was elevated to 1,211.2 ng/mL, and to 1,443.8 ng/mL after 2 weeks. Three weeks after leuprorelin injection and 4 weeks after bicalutamide administration, while serum testosterone level had already been suppressed to castration levels (0.34 ng/mL), the serum PSA reached a peak of 2,555.5 ng/mL (Fig. 1b). Thereafter, the serum PSA level decreased along with the patient’s back pain. The serum testosterone was completely suppressed to a level of 0.1 ng/mL and PSA nadir reached 1.0 ng/mL and remained at approximately 1 ng/mL for 6 months (Fig. 1c). The PSA serum level then began to increase again without elevation of testosterone and any clinical symptoms, including back pain. For the purpose of anti-androgen withdrawal syndrome (AWS), bicalutamide was discontinued, and the serum PSA level decreased again to less than 0.1 ng/mL. The patient is currently undergoing LH-RH agonist monotherapy and his serum PSA level has been maintained at less than 0.1 ng/mL for more than 30 months without any clinical symptoms (Fig. 1c).Fig. 1


Prior administration of a non-steroidal anti-androgen failed to prevent the flare-up caused by a luteinizing hormone-releasing hormone agonist in a patient with metastatic prostate cancer.

Uehara S, Yuasa T, Fujii Y, Yano A, Yamamoto S, Masuda H, Fukui I, Yonese J - BMC Res Notes (2015)

Imaging and the clinical schema of a symptomatic metastatic prostate cancer patient. a Initial bone scan images showing multiple bone metastases, which included the sacral bone (arrow). b Initial clinical schematic presentation with alteration of the serum prostate-specific antigen level. c Clinical schematic presentation of the whole process with alteration of the serum prostate-specific antigen level.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526290&req=5

Fig1: Imaging and the clinical schema of a symptomatic metastatic prostate cancer patient. a Initial bone scan images showing multiple bone metastases, which included the sacral bone (arrow). b Initial clinical schematic presentation with alteration of the serum prostate-specific antigen level. c Clinical schematic presentation of the whole process with alteration of the serum prostate-specific antigen level.
Mentions: A 70-year-old Asian man was referred to our hospital for treatment of prostate cancer. His serum prostate-specific antigen (PSA) level was 974.8 ng/mL and trans-perineal prostatic biopsy revealed prostate cancer, with a Gleason score 5 + 4. A whole-body bone scintigraphy demonstrated multiple bone metastases [extent of disease (EOD): 2] including the sacral bone (Fig. 1a). Magnetic resonance imaging (MRI) also indicated a metastasis at the same site, which was causing severe low back pain. The patient was hospitalized for pain control and started to undergo hormonal therapy. Prior administration of the non-steroidal anti-androgen, bicalutamide, was followed by injection of the LHRH-agonist, leuprorelin, after 1 week. However, severe back pain continued to increase with increased PSA serum level (Fig. 1b). One week after bicalutamide administration, serum PSA level was elevated to 1,211.2 ng/mL, and to 1,443.8 ng/mL after 2 weeks. Three weeks after leuprorelin injection and 4 weeks after bicalutamide administration, while serum testosterone level had already been suppressed to castration levels (0.34 ng/mL), the serum PSA reached a peak of 2,555.5 ng/mL (Fig. 1b). Thereafter, the serum PSA level decreased along with the patient’s back pain. The serum testosterone was completely suppressed to a level of 0.1 ng/mL and PSA nadir reached 1.0 ng/mL and remained at approximately 1 ng/mL for 6 months (Fig. 1c). The PSA serum level then began to increase again without elevation of testosterone and any clinical symptoms, including back pain. For the purpose of anti-androgen withdrawal syndrome (AWS), bicalutamide was discontinued, and the serum PSA level decreased again to less than 0.1 ng/mL. The patient is currently undergoing LH-RH agonist monotherapy and his serum PSA level has been maintained at less than 0.1 ng/mL for more than 30 months without any clinical symptoms (Fig. 1c).Fig. 1

Bottom Line: Then the serum level decreased again to less than 0.1 ng/mL.In this case, anti-androgen was probably not effective from the initial administration.Awareness of the possibility of ineffectiveness of anti-androgens is important in the treatment of symptomatic metastatic prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. sho.uehara@jfcr.or.jp.

ABSTRACT

Background: 'Flare phenomenon' after initial luteinizing hormone-releasing hormone agonist administration is a widely approved concept in the treatment of prostate cancer. In most guidelines, concomitant therapy with anti-androgens is recommended to prevent this flare phenomenon. However, there are few reports describing serum prostate-specific antigen transitions after hormonal therapy. Here, we present a case of a man who experienced the biochemical and clinical flare phenomenon despite prior anti-androgen use and who has detailed data.

Case presentation: A 70-year-old Asian man with metastatic prostate cancer (multiple bone) was referred to our hospital. He was treated with prior anti-androgens and luteinizing hormone-releasing hormone agonist. Regardless of prior use of anti-androgens, his low back pain caused by bone metastases was deteriorated and serum prostate-specific antigen level was raised from 974.8 ng/mL to 2,555.5 ng/mL within 3 weeks. Then, his serum prostate specific antigen level started to decrease along with the pain. The nadir reached 1.0 ng/mL and remained for 6 months. Because the serum level of prostate-specific antigen then began to increase again, anti-androgen was discontinued for anti-androgen withdrawal syndrome. Then the serum level decreased again to less than 0.1 ng/mL. Until now, his serum prostate-specific antigen level has been maintained at less than 0.1 ng/mL for more than 30 months without any clinical progressions.

Conclusion: We present the case of a patient in whom a clinical flare caused by an leuteinizing hormone-releasing hormone agonist was not prevented by prior anti-androgen administration. In addition, the nadir level of prostate-specific antigen when he received leuteinizing hormone-releasing hormone monotherapy was ten times lower than when he received concomitant therapy, and period of anti-androgen withdrawal syndrome was longer than usual. In this case, anti-androgen was probably not effective from the initial administration. Awareness of the possibility of ineffectiveness of anti-androgens is important in the treatment of symptomatic metastatic prostate cancer. Leuteinizing hormone-releasing hormone antagonist and surgical castration is a more reliable clinical approach for the prostate cancer patients with symptomatic metastatic disease.

No MeSH data available.


Related in: MedlinePlus