Assesment of treatment of prostate cancer by endocrine therapy at 103 military hospital – Nguyen Anh Tuan

Journal of military pharmaco-medicine n o 1-2019 145 ASSESMENT OF TREATMENT OF PROSTATE CANCER BY ENDOCRINE THERAPY AT 103 MILITARY HOSPITAL Nguyen Anh Tuan1; Tran Van Hinh1; Pham Quang Vinh1; Nguyen Phu Viet1 Dao Van Nhat1; Nguyen Dinh Duong1; Cao Quyet Thang1; Le Anh Tuan1 SUMMARY Objectives: To evaluate the results of treatment of prostate cancer by endocrine therapy. Subjects and methods: All cases with prostate cancer were diagnosed by histopathology, treated by endocrine. Evaluating the results after 3 months, 6 months, and over 1 year. Results: After endocrine therapy over 12 months, PSA total level < 4 ng/mL (53.16%); from 4 - 10 ng/mL: 27.84%; > 10 ng/mL: 11.39%. PSA total level decreased from 35.1 ± 1.2 ng/mL to 7.88 ± 5.15 ng/mL (p < 0.05). Good result: 88.61%; bad result: 11.39%. Conclusions: After treatment for over 12 months for 79 prostate cancer patients treated by endocrinology, total PSA levels were 10 ng/mL (11.39%). The total PSA level decreased from 35.1 ± 17.2 ng/mL to 7.88 ± 5.15 ng/mL, significantly different with p < 0.05. Good and moderate results after hormone treatment and follow-up was 88.61%. On the other hand, bad results accounted for 11.39%. * Keywords: Prostate cancer; PSA; Endocrine therapy. INTRODUCTION Prostate cancer is the leading cause of urologic diseases and the second most common cancer in men. It is more common in men over the age of 50, the second leading cause of death in the world after lung cancer [2, 5, 6]. In Vietnam, the incidence of prostate cancer is increasing, possibly due to the growing economic conditions, the longevity of life. With today's modern screening and diagnostic facilities such as ultrasonography, blood PSA quantification, prostate biopsy as histopathology [3], along with advanced treatment techniques such as combination therapy and radical surgery, radiotherapy, chemotherapy and endocrine treatment are the chosen methods, which are suitable with the disease as well as the current socio-economic conditions of our country. Currently, endocrine treatment is a highly effective treatment method that is widely used in many domestic and international health facilities, especial for patients with the end stage of prostate cancer [1, 4]. Vietnamese studies on endocrine treatment for patients with prostate cancer are not much. From that fact, we conducted the research aimed at: Assessment of prostate cancer by endocrine therapy at 103 Military Hospital. 1. 103 Military Hospital Corresponding author: Tran Van Hinh (hinhhvqy@gmail.com) Date received: 20/10/2018 Date accepted: 17/12/2018 Journal of military pharmaco-medicine n o 1-2019 146 SUBJECTS AND METHODS 1. Subjects. - 79 prostate cancer patients were diagnosed with prostate cancer based on histopathological findings, treated and surveyed at the Urological Surgery Department of the 103 Hospital from 1 - 2013 to 5 - 2018. - Criteria for selecting patients: + Diagnosed finally prostate cancer by histopathology. + Used endocrine agents with enough dose and times at 103 Military Hospital. + Full documentation of clinical, treatment and development during hospitalization. - Exclusion criteria: + Patients do not agree to enroll in the study. + Patients who are diagnosed with histopathology and treatment by other medical centers. Patients diagnosed with prostate cancer without histologic results, incomplete records of treatment and follow-up. 2. Methods. - Case, description study. - Process: Patients were diagnosed with prostate biopsy on histopathology, histopathological classification, Gleason score, blood PSA level before and after endocrine treatment 3 months, 6 months and over 1 year. - Endocrine agents: Diphereline 3.75 mg every 3 months. - There are 3 levels of evaluation: + Good: Total PSA level < 4 ng/mL; no distant metastasis; duration of living over 3 years. + Moderate: Total PSA level 4 - 10 ng/mL; complications. + Bad: Total PSA > 10 ng/mL; there are distant metastases. * Data processing: Data were entered and processed by statistical software in SPSS 16.0 and Excel 2010. RESULTS AND DISCUSSION 1. Characteristics of patients. * Age of patients (n = 48): < 50 years old: 1 patient (1.26%); 51 - 60 years old: 4 patients (5.06%); 61 - 70 years old: 28 patients (35.44%); 71 - 80 years old: 30 patients (37.97%); > 80 years old: 17 patients (21.51%). The mean age of patients with prostate cancer in this study was 71.25 ± 7.7. The youngest was 48, the oldest was 94. The age over 80 accounted for not high. In Vietnam, there is no specific research on age with a large scale, but many authors recognized that prostate cancer is the major disease of older men. In our study, the prevalence of the disease increased with age, particularly in the 61 - 80 age groups (73.51%). The prevalence of this disease was less than 6.32% in the age group 50 - 60 years old. This result was consistent with that of Nguyen Viet Hai (2013). The incidence of the disease increased with age, most commonly in the 61 - 80 age group, but the highest Journal of military pharmaco-medicine n o 1-2019 147 was in the 71 - 80 age group [2], and also higher in the average age of the disease [6, 8]. This can be explained by the fact that the health care system with prostate cancer screening in highly productive countries has helped to diagnose early onset of metastatic disease. This is important for survival time and quality of life. Moreover, early detection and timely treatment with multiple methods also reduce the risk of death. Table 1: Features of differentiation of cells in the study group. Differentiation of cells n Percentage (%) High (Gleason 2 - 4 scores) 12 15.18 Moderate (Gleason 5 - 7 scores) 45 56.96 Low (Gleason 8 - 10 scores) 22 27.84 Total 79 100 There were no significant differences in the number of authors (Bostwick, Nguyen Viet Hai, 98.6%). Other histopathologic lesions of the prostatic hypertrophy were sarcoma and urothelial carcinoma (3.8%). According to the classification based on Gleason points, the most useful classification in prostate cancer, the study showed the most common was the low and medium cell differentiation (84.80%), high cell differentiation was less common. The results of this study were well suited to other domestic and international studies [2, 7]. High differentiation with good prognosis, especially those with non-invasive prostate gland tumor, non-invasive lymph nodes are able to completely cure, so have better prognosis, long life after treatment, long low ability to respond to treatment, aggressive invasive disease, high rate of metastasis, rapid progression and death in short time. * Histopathological features: Urothelial: 1 patient (1.26%); sarcoma: 2 patients (2.53%); carcinoma: 76 patients (96.2%). * Total PSA serum levels before endocrine treatment: < 10 ng/mL: 3 patients (3.79%); 10 - 20 ng/mL: 11 patients (13.92%); 20.1 - 50 ng/mL: 26 patients (32.91%); 50.1 - 100 ng/mL: 35 patients (44.30%); > 100 ng/mL: 4 patients (5.06%). PSA levels were very high in 79 patients, showed that most patients admitted to the hospital late; average PSA 35.1 ± 17.2 ng/mL. Total serum total PSA levels are an important predictor of disease but have no predictive effect, evaluating the outcome after endocrine treatment due to no predictable duration of drug resistance and survival time. Increased PSA levels prior to treatment and postprandial depletion are more likely to be fatal than cases of full-blown PSA before treatment and post-treatment reductions [5]. In our study, total serum total PSA serum level was higher than 10 ng/mL, accounting for 96.31%. According to Nguyen Viet Hai and other domestic and foreign authors, we also found that early detection of PSA < 10 ng/mL and lowering of the diagnostic age could completely cure the disease and significantly reduce death, prolong life of patients. Journal of military pharmaco-medicine n o 1-2019 148 2. Results. Table 2: PSA levels after 3 months, 6 months, and over 1 year (n = 79). PSA serum levels (ng/mL) 3 months 6 months Over 1 year < 4 12 35 42 4 - 10 44 32 28 > 10 23 12 9 Total 79 79 79 Mean of PSA 12.88 ± 7.35 9.88 ± 6.35 7.88 ± 5.15 Min-max of PSA 3.25 - 48.52 ng/mL 2.25 - 25.52 ng/mL 1.5 - 20.50 ng/mL In our study, patients were tested for serum PSA after treatment. After 3 months of treatment, patients had PSA levels of 4 - 10 ng/mL accounted for the highest rate (55.69%). Patients with PSA > 10 ng/mL remained relatively high at 29.11%. Through endocrine treatment and follow-up of serum PSA levels after 6 months and more than one year, we found that patients with PSA < 4 ng/mL had significantly increased, accounting for 53.16%. Patients with PSA > 10 ng/mL reduced to 11.39%. Table 3: Treatment results. Results 3 months 6 months Over 1 year Good 15.18 44.3 53.16 Moderate 55.69 40.5 35.44 Bad 29.11 15.51 11.39 There is currently no standard for the evaluation of prostate cancer treatment outcomes. Our study based on serum total PSA variability after 3 months, 6 months and over 1 year of treatment. The results showed that the rate of good results and average after treatment by hormone and follow-up accounted for a high rate (88.61%). Bad results accounted for 11.39% due to the number of patients coming to the clinic in the late stage, due to low level of knowledge, no sense of follow-up appointment for additional treatment in time. Total PSA decreased from 35.1 ± 11.2 ng/mL to 7.88 ± 5.15 ng/mL, significant difference with p < 0.05. We found a significant reduction in total PSA levels in the Gleason group of patients, with a statistically significant difference with p < 0.05. CONCLUSIONS Through study of 79 prostate cancer patients treated by endocrinology, we draw some comments: - After treatment for over 12 months, total PSA levels were < 4 ng/mL (53.16%); 4 - 10 ng/mL (27.84%); > 10 ng/mL (11.39%). Journal of military pharmaco-medicine n o 1-2019 149 - The total PSA level decreased from 35.1 ± 17.2 ng/mL to 7.88 ± 5.15 ng/mL, significantly different with p < 0.05. - Good and moderate results after hormone treatment and follow-up were 88.61%. - Bad results accounted for 11.39%. REFERENCES 1. Nguyễn Hoàng Đức, Trần Lê Linh Phương. Một số quan điểm mới về điều trị nội tiết trong ung thư tuyến tiền liệt. Thời sự Y học. 2006, 11, tr.35-42. 2. Nguyễn Việt Hải. Nghiên cứu mô bệnh học và chẩn đoán ung thư tuyến tiền liệt. Luận án Tiến sỹ Y học. Học viện Quân y. Hà Nội. 2013. 3. Vũ Văn Tỵ. Tầm soát ung thư tuyến tiền liệt. Tạp chí Y học Việt Nam. 2010, 2, tr.282-285. 4. Abrahamsson P.A, Anderson J, Boccon- Gibod L et al. Risks and benefits of hormonal manipulation as monotherapy or adjuvant treatment in localized prostate cancer. Eur Urol. 2005,48 (6), pp.900-905. 5. Bostwick D. G, Liu L, Brawer M.K et al. High-grade prostatic intraepithelial neoplasia. 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