1/12. Undetectable prostate-specific antigen response with bicalutamide withdrawal phenomenon.Several reports have described the antiandrogen withdrawal syndrome with various nonsteroidal antiandrogen agents. To our knowledge, there have been no reports describing a durable undetectable prostate-specific antigen (PSA) response with discontinuation of the antiandrogen agent bicalutamide (Casodex, Zeneca, Wilmington, DE, U.S.A.). We report a case in which a decline of serum PSA to undetectable levels was achieved with bicalutamide discontinuation.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/12. Complete response, as determined by prostate-specific antigen level, to chlormadinone acetate withdrawal persisting longer than 2 years in patients with advanced prostate cancer: two case reports.Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.- - - - - - - - - - ranking = 0.8keywords = antigen (Clic here for more details about this article) |
3/12. Acute liver decompensation on withdrawal of cytotoxic chemotherapy and immunosuppressive therapy in hepatitis B carriers.Five chronic carriers of hepatitis b virus developed a fulminant hepatitis-like picture when immunosuppression or cytotoxic treatment, given for unrelated disorders, was withdrawn. Viral replication at the time of the final illness was confirmed in three of the five cases by measurement of serum HBV dna or the presence of HBc antigen on liver biopsy. A cytoplasmic and nuclear pattern of HBc was seen in histological material during life, but at post-mortem was limited to a nuclear distribution, suggesting greater destruction of hepatocytes containing cytoplasmic HBc. In two of the cases, chronic liver disease was found at post-mortem, there being no previous clinical or laboratory abnormality, but it is unlikely that this was a factor in the development of the superimposed fulminating hepatitis-like illness. Immunosuppressive and cytotoxic agents must be used with extreme caution in any hepatitis B carrier, as withdrawal can precipitate acute decompensation regardless of whether or not there is underlying chronic liver disease.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
4/12. Fulminant hepatic failure in nephrotic syndrome related to withdrawal of immunosuppressive therapy.Two patients with nephrotic syndrome developed fatal fulminant hepatitis B following withdrawal of prednisolone or cyclophosphamide. Immunosuppressive therapy probably enhanced hepatitis b virus (HBV) replication and widespread infection of hepatocytes; its withdrawal permitted a return of immune competence resulting in massive destruction of infected hepatocytes. Prior screening of all patients for hepatitis B surface antigen, gradual withdrawal of immunosuppressive drugs with careful monitoring, and prompt intervention with corticosteroids at the first clinical or biochemical signs of liver cell damage may prevent this complication.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
5/12. Fulminant hepatic failure in leukaemia and choriocarcinoma related to withdrawal of cytotoxic drug therapy.In three patients with malignant disease HBsAg was detected in the serum at least 6 months before the development of acute hepatitis type B, which in each case followed a fulminant course to death. It is suggested that suppression of the normal immunological responses to hepatitis-B viral antigens by cytotoxic drug therapy permitted widespread infection of hepatocytes. Subsequently, upon withdrawal of these drugs, recovery of immunocompetence resulted in rapid destruction of all infected hepatocytes and massive liver damage. Screening for HBsAg before cytotoxic drug therapy, careful monitoring of liver function during its withdrawal, and prompt treatment with corticosteroids should abnormalities occur may prevent this unfortunate sequence of events.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
6/12. prostate-specific antigen decline after casodex withdrawal: evidence for an antiandrogen withdrawal syndrome.OBJECTIVE. To evaluate the relationship between antiandrogen withdrawal and change in prostate-specific antigen (PSA) when the antiandrogen in question is other than flutamide. methods. Presented is a case of a patient in whom the antiandrogen casodex was discontinued after clinical progression despite combined androgen blockade. RESULTS. A transient decline in serum PSA was observed after casodex withdrawal. CONCLUSIONS. The relationship between antiandrogen withdrawal and a change in PSA may be a general phenomenon, not unique to flutamide.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/12. Withdrawal phenomenon with the antiandrogen casodex.Total androgen blockade with castration and antiandrogens has become the primary therapy in metastatic prostate carcinoma. Several reports have been published on the flutamide withdrawal syndrome with a favorable response in patients with progression of disease after lengthy remission while taking combined hormone therapy. The experience with withdrawal of the experimental nonsteroidal antiandrogen casodex in 3 patients is reported. All patients received casodex monotherapy initially, then luteinizing hormone-releasing hormone analogues were added on progression of disease (bone scan and prostate specific antigen [PSA]) and eventually casodex was withdrawn on further progression of disease (PSA and bone scan). Two patients had declines in PSA levels of 42% and 75% sustained for 3 to 6 months, and 1 patient had a stable condition for 2 months. These responses were similar to those of withdrawal of flutamide, which were limited to patients who had received combination therapy at the onset of treatment. Thus, the observations in this report would suggest that the initial and sustained exposure to an antiandrogen is the more important factor in the withdrawal phenomenon rather than the low androgen environment alone that occurs with initial luteinizing hormone-releasing hormone analogue monotherapy, orchiectomy or combination luteinizing hormone-releasing hormone analogue and antiandrogen.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
8/12. Antiandrogen withdrawal syndrome in prostate cancer after treatment with steroidal antiandrogen chlormadinone acetate.OBJECTIVES. A case report is presented of 2 patients whose levels of serum prostate-specific antigen (PSA) improved after the withdrawal of a steroidal antiandrogen. methods. Two cases with prostate cancer had been treated with surgical castration and the steroidal antiandrogen chlormadinone acetate (CMA), and, on disease progression, the administration of CMA was terminated. RESULTS. Following withdrawal of CMA, a fall in PSA levels and remarkable clinical improvement were observed in both cases. One patient revealed a decrease and the other an increase in serum prostate acid phosphatase after the discontinuation of CMA. serum levels of testosterone, prolactin, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione were not significantly elevated after CMA withdrawal. CONCLUSIONS. Withdrawal of the steroidal antiandrogen CMA resulted in a decline in PSA levels and clinical improvement in prostate cancer patients with disease progression. Changes in testosterone, prolactin, or adrenal androgens were not a cause of the antiandrogen withdrawal syndrome.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
9/12. Dramatic prostate specific antigen decrease in response to discontinuation of megestrol acetate in advanced prostate cancer: expansion of the antiandrogen withdrawal syndrome.We report a dramatic decrease in prostate specific antigen in response to the discontinuation of megestrol acetate in a patient with progressive metastatic prostate cancer. Our case demonstrates that withdrawal responses may occur with steroidal and nonsteroidal antiandrogens.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/12. Prostate specific antigen decline after antiandrogen withdrawal: the flutamide withdrawal syndrome.Post-therapy changes in prostate specific antigen (PSA) have been proposed as a surrogate end point for response in clinical trials of patients with hormone refractory prostatic cancer. While the specific criteria for response are evolving, there are concerns that changes in serum levels of PSA may be the result of changes in PSA expression or secretion independent of effects on cell growth and proliferation. We report 3 representative cases receiving complete androgen blockade with either gonadotropin-releasing hormone or orchiectomy plus the antiandrogen flutamide, which demonstrated sustained declines in serum PSA levels after discontinuation of the antiandrogen. Similar results have been observed in 6 additional patients. Whether this represents an agonist effect of the antiandrogen is unknown. The results suggest that a trial of flutamide withdrawal is justified in an asymptomatic patient with an increasing PSA before treatment with more toxic therapies. It also shows the importance of documenting sequential elevations in the marker before enrolling a patient in a clinical trial, and that changes in PSA must be interpreted cautiously in clinical trials when an antiandrogen is discontinued.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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