STRATIFICATION OF STAGE D2 PROSTATE-CANCER PATIENTS BY A DISEASE AGGRESSIVENESS SCORE AND ITS USE IN EVALUATING DISEASE RESPONSE AND OUTCOME TO COMBINATION HORMONAL TREATMENT (GNRH-A PLUS FLUTAMIDE)

Suppression of androgen levels of stage D2 prostate cancer patients ha s been the prominent treatment for advanced prostate cancer. An arithm etic formula expressing disease aggressivity computed by the pre-treat ment levels of alkaline phosphatase (AP), degree of tumor differentiat ion and number of bone metastases correlated well with disease respons e and outcome in stage D2 patients treated by chronic administration o f the gonadotropin-releasing hormone agonistic analogues (GnRH-As; bus erelin) or orchiectomy. In the present study we analyzed retrospective ly disease response and outcome in 262 previously untreated stage D2 p rostate cancer patients who received combination hormonal treatment (G nRH-A plus flutamide) using this aggressiveness score. Mean value of t his aggressiveness score between patients who Mean grouped with refere nce to type of disease response according to the criteria established by the National Prostatic Cancer Project (NPCP) was statistically diff erent (Kruskal-Wallis, p>0.001). Pairwise comparison documented that t his was true between all but the stable and progression groups. Linear regression analysis documented significant correlation of this aggres siveness score with length of response and survival (r=0.59, and 0.45, respectively: p>0.0001). Analysis of slopes obtained by linear regres sions between agressiveness score and survival in patients treated wit h GnRH-A plus flutamide and with GnRH-A monotherapy documented that di sease response and outcome was superior among patients who received co mbination hormonal treatment. These data indicate that this aggressive ness score correlated well type of disease response, length of respons e, and survival with patients given combination hormonal treatment, an d as such it can be used as an objective tool for analysizing clinical data.