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Long-term complete response of antiandrogen withdrawal syndrome in a patient with metastatic prostate cancer: A case report

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ABSTRACT

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer treated with combined androgen blockade (CAB). AWS is generally defined as subjective and/or objective improvement following discontinuation of an antiandrogen. However, the duration of the AWS response is usually limited. In addition, a complete response is quite rare. We herein present the case of a patient who achieved complete response from AWS, with the duration of this response lasting for >6 years. A 72-year-old man with metastatic prostate cancer received CAB with a luteinizing hormone-releasing hormone analog and bicalutamide. In addition, for local cancer control, external beam radiation therapy (70 Gy) to the prostate was performed. Subsequently, the serum prostate-specific antigen (PSA) level reached a nadir (undetectable level). Four years later, the patient's serum PSA level started to rise, and bicalutamide was discontinued to confirm AWS at a serum PSA level of 0.34 ng/ml. The PSA level immediately decreased again to an undetectable level (0.00 ng/ml), where it has been remained for 6 years. Bone scintigraphy and computed tomography scans have shown no evidence of bone or other metastases since the introduction of AWS. To the best of our knowledge, there have been no reports of such a long duration of complete response from AWS. Therefore, this phenomenon should always be considered, even in patients with advanced disease.

No MeSH data available.


Change in serum PSA concentration in the patient treated with combined androgen blockade and after cessation of the non-steroidal antiandrogen bicalutamide. EBRT, external beam radiation therapy; PSA, prostate-specific antigen.
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f1-mco-0-0-946: Change in serum PSA concentration in the patient treated with combined androgen blockade and after cessation of the non-steroidal antiandrogen bicalutamide. EBRT, external beam radiation therapy; PSA, prostate-specific antigen.

Mentions: The PSA level gradually increased to 0.34 ng/m by March 3, 2009; however, no new lesions of distant metastasis were detected by CT or bone scintigraphy. Bicalutamide was discontinued to confirm AWS. The PSA level again decreased to 0.00 ng/ml by August 18, 2009. To date, this undetectable PSA level has been maintained, and no recurrence has been detected by bone scintigraphy or CT for the past 6 years since the introduction of AWS. The clinical course and change in serum PSA levels are shown in Fig. 1.


Long-term complete response of antiandrogen withdrawal syndrome in a patient with metastatic prostate cancer: A case report
Change in serum PSA concentration in the patient treated with combined androgen blockade and after cessation of the non-steroidal antiandrogen bicalutamide. EBRT, external beam radiation therapy; PSA, prostate-specific antigen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997963&req=5

f1-mco-0-0-946: Change in serum PSA concentration in the patient treated with combined androgen blockade and after cessation of the non-steroidal antiandrogen bicalutamide. EBRT, external beam radiation therapy; PSA, prostate-specific antigen.
Mentions: The PSA level gradually increased to 0.34 ng/m by March 3, 2009; however, no new lesions of distant metastasis were detected by CT or bone scintigraphy. Bicalutamide was discontinued to confirm AWS. The PSA level again decreased to 0.00 ng/ml by August 18, 2009. To date, this undetectable PSA level has been maintained, and no recurrence has been detected by bone scintigraphy or CT for the past 6 years since the introduction of AWS. The clinical course and change in serum PSA levels are shown in Fig. 1.

View Article: PubMed Central - PubMed

ABSTRACT

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer treated with combined androgen blockade (CAB). AWS is generally defined as subjective and/or objective improvement following discontinuation of an antiandrogen. However, the duration of the AWS response is usually limited. In addition, a complete response is quite rare. We herein present the case of a patient who achieved complete response from AWS, with the duration of this response lasting for >6 years. A 72-year-old man with metastatic prostate cancer received CAB with a luteinizing hormone-releasing hormone analog and bicalutamide. In addition, for local cancer control, external beam radiation therapy (70 Gy) to the prostate was performed. Subsequently, the serum prostate-specific antigen (PSA) level reached a nadir (undetectable level). Four years later, the patient's serum PSA level started to rise, and bicalutamide was discontinued to confirm AWS at a serum PSA level of 0.34 ng/ml. The PSA level immediately decreased again to an undetectable level (0.00 ng/ml), where it has been remained for 6 years. Bone scintigraphy and computed tomography scans have shown no evidence of bone or other metastases since the introduction of AWS. To the best of our knowledge, there have been no reports of such a long duration of complete response from AWS. Therefore, this phenomenon should always be considered, even in patients with advanced disease.

No MeSH data available.