Long-term treatment outcomes of intermittent androgen deprivation therapy for relapsed prostate cancer after radical prostatectomy.

PURPOSE:Intermittent androgen deprivation therapy is an effective treatment for metastatic prostate cancer. However, no study to date has evaluated the long-term outcomes of this treatment among patients with prostate cancer after radical prostatectomy. We retrospectively examined the treatment outcomes of patients with prostate-specific antigen recurrence who underwent radical prostatectomy at our department. MATERIALS AND METHODS:Of the 690 patients who underwent radical prostatectomy for local prostate cancer between 1988 and 2011, 129 patients who received androgen deprivation therapy for prostate-specific antigen recurrence were included in this study. Patient characteristics, luteinizing hormone-releasing hormone agonist administration, and outcomes were compared between the intermittent androgen deprivation group (n = 66) and the continuous androgen deprivation therapy group (n = 63). The non-recurrence and overall survival rates were compared between groups. RESULTS:Thirty-six patients (27.9%) experienced recurrence after luteinizing hormone-releasing hormone agonist administration. The 5-year non-recurrence rate and 10-year overall survival rate were higher in the intermittent group (92.9%) than in the continuous group (92.9 vs 57.9%, P < 0.001; and 95.9% vs 84.3%, P = 0.047, respectively). Furthermore, 63 patients (48.8%) showed a PSA nadir of less than 0.01 ng/mL after initiation of luteinizing hormone-releasing hormone agonist; among these patients, the non-recurrence rate was significantly higher in the intermittent androgen deprivation group (P = 0.003). CONCLUSIONS:Intermittent androgen deprivation therapy for prostate specific antigen recurrence after radical prostatectomy contributed to improvement of the non-recurrence rate and overall survival, and can be considered an effective therapy for better prognosis

Successful Surgical Treatment of an Infected Thoracoabdominal Aneurysm Accompanied with Leriche Syndrome

A 56-year-old man presenting with massive melena and loss of consciousness was diagnosed with an infected thoracoabdominal aneurysm, an aortoduodenal fistula, and Leriche syndrome following an evaluation by computed tomography. Emergency surgery for uncontrolled infection included the reconstruction of the superior mesenteric and bilateral renal arteries using a four-branched graft. The aortoduodenal fistula was resected after omental filling, and an enterostomy was performed for feeding. Intestinal reconstruction was performed in two stages. The patient was discharged on postoperative day 48 and was without evidence of recurrence at 23 months postoperatively

Mean PSA level prior to posterior LHRHa therapy in the IAD group.

<p>Mean PSA level prior to posterior LHRHa therapy in the IAD group.</p

The non-recurrence rate and survival rate of the IAD group and the CAD group with Gleason Score ≤ 7.

<p>Kaplan-Meier analysis of progression-free survival (A) and overall survival (B) in both two groups in patients with Gleason Score ≤ 7.</p

The median duration of time on treatment or time off treatment in the IAD group.

<p>The median duration of time on treatment or time off treatment in the IAD group.</p

The non-recurrence rate of the IAD group and the CAD group with PSA ≤ 0.01 ng/ml.

<p>Kaplan-Meier analysis of progression-free survival in the patients who showed a PSA nadir of less than 0.01 ng/ml after LHRHa administration.</p

Characteristics of patients treated with IAD and CAD.

<p>Characteristics of patients treated with IAD and CAD.</p

The non-recurrence rate and survival rate of the IAD group and the CAD group.

<p>Kaplan-Meier analysis of progression-free survival (A) and overall survival (B) in the IAD group and CAD group.</p