Analysis Of Using Hormonal Therapy In The Patients With PSA Failure After Radical Prostatectomy

Background and Objectives For the widely using of prostate specific antigen(PSA)screening and promotion of people's recognition of prostate cancer's high prevalence,the incidence of prostate cancer increased annually from the last decade in China.Accountingly,with the application of PSA screening and ultrasonography guided systemic prostate biopsy,the percentage of detection of the low-risk disease has been increased dramatically.Simultaneously,the improving of the surgical technique made more patients can have radical prostatectomy.But unfortunately,a comparative percentage of patients will experience a biochemical recurrence though they had a radical desection.This ratio could be 20 percentage in patients that were just five years after they had undergone the radical prostatectomy.If not have salvage therapy,these patients,especially for the high-risk ones,will die from the advance of prostate cancer.Hormonal therapy could be a choice for this case.This article approached the effect of adjuvant hormonal therapy in patients experienced biochemical failure after radical prostatectomy,and the comparision between immediately therapy and delayed therapy.Materials and Methods In all of the patients that had radical prostatectomy in Sir Run Run Shaw hospital during 2004 to 2008,15 cases were determined to have experienced biochemical failure.All these patients' PSA level failed to fall to undetectable levels after surgery(ranged from 0.24-5.14 ng/ml with the average 1.394±1.536 ng/ml).Pre-surgery PSA levels:7 cases ranged from 10-20 ng/ml(5.95-17.16 ng/ml,average 10.61±3.55 ng/ml);8 patients were higher than 20 ng/ml(20.8-90.36 ng/ml, average 45.16±24.42 ng/ml).Gleason score:7 cases lower than 7,3 case were 7,5 cases ranged from 8-10.10 patients belonged to high-risk group for recurrence and 5 were low-risk ones.8 patients had given the immediately adjuvant hormonal therapy,another 7 cases were followed and given the delayed therapy while the PSA levels increased.All the patients had the antiandrogen monotherapy(Bicalutamide or Flutamide only). Collecting the data of the post-operation PSA levels at 3 weeks,the PSA levels at the start of hormonal therapy,the PSA levels at 3 month after hormonal therapy.Using paired design and t-test to determine the effect of therapy of either group.Using two samples' average analysis and t' -test to determine the effect between immediately therapy and delayed therapy.Result For immediately therapy group,PSA levels at the start of therapy vs PSA levels at 3 month after therapy:t=2.54,p＜0.05,with significant difference.For delayed therapy group,PSA levels at the start of therapy vs PSA levels at 3 month after therapy:t=3.21,p＜0.05 with significant difference.But the comparison of PSA decline between the two groups was not of significant difference(p＞0.05).Thus,adjuvant hormonal therapy after radical prostatectomy can delay the disease progression.But there is no significant difference between immediately therapy and delayed therapy. But for the high-risk patients of both groups,in immediately therapy group PSA levels at the start vs PSA levels at 3 month has significant difference (t=3.35,p＜0.05),and in delayed ones there is no significant difference (t=2.35,p＞0.05).So it is effective to use adjuvant hormonal therapy in patients of high-risk group.Conclusion Adjuvant hormonal therapy after radical prostatectomy can delay the disease progression.But there is no significant difference between immediately therapy and delayed therapy.Fortunately,in patients of high-risk group,adjuvant hormonal therapy seems to be effective.