Rapid Progression of Advanced “Hormone-Resistant” Prostate Cancer During Palliative Treatment with Progestins for Cancer Cachexia

Tassinari, Davide; Fochessati, F.; Panzini, Ilaria; Poggi, B.; Sartori, Sergio; Ravaioli, Alberto

doi:10.1016/s0885-3924(03)00043-5

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…Megestrol acetate is commonly utilized for the treatment of hot flashes in men receiving ADT and has been reported to reduce hot flashes by up to 85% [50]. A few case reports describe progression of prostate cancer with megestrol acetate; therefore, monitoring of disease is important [51,52]. Depot medroxyprogesterone acetate (MPA) has been studied as an intervention to reduce hot flashes in men on ADT.…”

Section: Management Of Adt Effects On Neuroendocrine and Neuropsycmentioning

confidence: 99%

Management of complications of androgen deprivation therapy in the older man

Mohile

Mustian

Bylow

et al. 2009

Critical Reviews in Oncology/Hematology

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Prostate cancer is the most common malignancy in older men. With the aging of the population, the number of older men with prostate cancer will grow rapidly. Androgen deprivation therapy (ADT) is the mainstay of treatment for men with systemic disease and is increasingly utilized as primary therapy or in combination with other therapies for localized disease. Side effects of therapy are multifold and include hot flashes, osteoporosis, and adverse psychological and metabolic effects. Recent research has illustrated that ADT can negatively impact the functional, cognitive, and physical performance of older men. Patients with prostate cancer, despite recurrence of the disease, have a long life expectancy and may be subjected to the side effects of ADT for many years. This review highlights the complications of ADT and approaches to management. We also provide recommendations for assessment and management of ADT complications among the most vulnerable and frail older male patients.

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Section: Management Of Adt Effects On Neuroendocrine and Neuropsycmentioning

confidence: 99%

Management of complications of androgen deprivation therapy in the older man

Mohile

Mustian

Bylow

et al. 2009

Critical Reviews in Oncology/Hematology

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“…Tassinari et al also reported the cases of three patients with advanced "hormone-resistant" prostate cancer, each of whom had rapid disease progression during their treatment with MA for cancer-associated cachexia. However, when MA was discontinued for inefficacy reasons, serum PSA values quickly stopped increasing, bone pain decreased, and patient performance status improved (19). Although it was not case regarding the administration of MA in patients with CRPC, one case report showed that patients with prostate cancer who were given MA for symptomatic relief of hot flashes after administration of a luteinizing hormone-releasing hormone analog, experienced a PSA value which declined more than 60% when MA therapy was stopped (25).…”

Section: Discussionmentioning

confidence: 99%

“…It has been also reported that mutation in the steroid binding domain of the androgen receptor was found in the human prostatic carcinoma cell line or in tissue from men with advanced prostate cancer (18). In this context, three case reports showed rapid progression of advanced CRPC during palliative treatment with MA for cancer cachexia (19). Therefore, MA might induce the proliferation of CRPC via the mutated androgen receptor.…”

Section: Introductionmentioning

confidence: 99%

Safety of Megestrol Acetate in Palliating Anorexia-Cachexia Syndrome in Patients with Castration-Resistant Prostate Cancer

et al. 2013

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There are concerns whether megestrol acetate (MA) stimulates the growth of prostate cancer in castration-resistant prostate cancer (CRPC). We evaluated the effect of cumulative doses of MA on the disease-specific survival (DSS) in patients with CRPC who were receiving Docetaxel-based chemotherapy. From July 2003 through June 2009, we identified 109 consecutive patients with CRPC and who had received docetaxel-based chemotherapy. Of these patients, 68 (62.4%) have not received MA, whereas 21 patients (19.3%) and 20 patients (18.3%) had received low dose MA (total ≤ 18,400 mg) and high dose MA (total > 18,400 mg), respectively. We assessed the effect of several variables on DSS. None of the clinicopathological variables differed among the three groups. When comparing DSS using Kaplan-Meier analysis, there was no statistically significant survival differences among the three groups (P = 0.546). Using multivariate Cox proportional analyses with backward elimination, the number of docetaxel cycles was only significant factor predicting DSS (HR: 0.578, 95% CI: 0.318-0.923, P = 0.016). Cumulative doses of MA as adjuvant treatment for patients with CRPC and who are receiving docetaxel-based chemotherapy, did not affect their DSS. Therefore, MA can be safely administered in cachexic patients with CRPC.

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“…Also, the inclusion of patients still receiving antineoplastic treatment and/or those who have relatively short follow-up can underestimate treatment-associated morbidity and the potentially harmful consequences of a hormonal treatment even in this setting. 4 However, in well-designed studies, the superiority of high-dose progestins compared to placebo is clearly demonstrated, 5 and was the main reason to include one of these drugs (medroxyprogesterone acetate) in our trial.…”

Section: Authors' Responsementioning

confidence: 92%