At present, no consensus exists regarding the use of second-line chemotherapy in patients with hormone-refractory prostate cancer (HRPC). A total of 23 patients with evidence of disease progression during or after first-line chemotherapy (epirubicin, etoposide, and dexamethasone) were included in this study. Two second-line treatments were administered throughout the study period (2000-2004) with 15/23 patients receiving carboplatin AUC 3 on day 1 and vinblastine 5 mg/m2 on day 1 of a 21-day cycle and 8/23 patients treated with docetaxel 50 mg/m2 on day 1 of a 21-day cycle. The latter regimen has been used since 2003. The prostate-specific antigen (PSA) level decreased by > or =50% in 3 of 23 patients, corresponding to an overall PSA response rate of 13% (95% confidence interval, 3-34%). The median time to biochemical progression was 9, 24 and 33 weeks, respectively. The median overall survival was 39 weeks (range, 15-73 weeks) with no difference between the two chemotherapy groups (p=0.08). A significant reduction of analgesic use was observed in 2 of 10 patients (20%) who required analgesics for cancer pain upon study entry. The major toxicity was grade 3 thrombocytopenia in 2 of 23 patients (9%). Both second-line treatments, a combination of carboplatin and vinblastine and a monotherapy with docetaxel, showed modest activity at subtoxic doses in patients with HRPC.

BACKGROUND:Recent studies have demonstrated the efficacy and favorable toxicity profile of chemotherapy regimens given at lower doses and frequent intervals. The aim of our study was to evaluate the efficacy and toxicity of a bi-weekly chemohormonal regimen consisting of epirubicin, etoposide, and low-dose dexamethasone (EED) in patients with hormone-refractory prostate cancer (HRPC).METHODS:We treated a total of 32 patients who had failed hormonal therapy and antiandrogen withdrawal. Chemotherapy was given every 2 weeks and consisted of epirubicin (30 mg/m2 intravenously, day 1) and etoposide (50 mg/m2 orally, days 1-7). Dexamethasone (1.5 mg orally, every other day) was given continuously until disease progression. Twenty patients (63%) had received prior treatment with estramustine phosphate. Each patient's pain response was evaluated according to analgesic use. Toxicity was graded using the Common Toxicity Criteria (version 2.0).RESULTS:Prostate-specific antigen (PSA) levels showed a decline of 50% or greater in 16 of 32 patients (50%, 95% confidence interval [CI], 32-68%) with a median time to biochemical progression of 5 months (range, 4-9 months). The median survival for all patients was 10.5 months (range, 3-35 months). Four of 10 patients (40%) with measurable soft tissue lesions achieved partial response according to standard criteria. Eleven of 23 symptomatic patients (48%, 95% CI, 27-69%) experienced an improvement in pain with a median duration of 6 months. The regimen was tolerated well by the patients, with only four patients (12%) having grade 3 leukopenia.CONCLUSION:Chemohormonal EED regimen proved to be active and well-tolerated in patients with HRPC.

Karcinom prostaty byl v roce 1997 v CR na druhem mistě v poctu hlasených malignit hned za nadory plicnimi. Incidence u karcinomu prostaty byla v roce 1997 52,9/100 000 mužů. Karcinom mocoveho měchýře byl v CR v roce 1997 sestým nejcastěji hlaseným malignim onemocněnim u mužů s incidenci 27/100 000 mužů. V letech 1989 - 2000 bylo na Urologicke klinice ve Fakultni nemocnici v Hradci Kralove provedeno 164 cystoprostatektomii pro zakladni diagnozu karcinomu mocoveho měchýře. Tkaň prostat byla prořezana od apexu k bazi v transverzalnich rovinach vzdalených 5 mm. Ze 157 hodnocených vzorků byl adenokarcinom prostaty zjistěn ve 23 (14,6 %) připadech. U žadneho pacienta nebyly prokazany vzdalene metastazy a pouze u 3 pacientů z 23 (13 %) byly histologický prokazany metastazy v regionalnich lymfatických uzlinach. V kategorii T byly nejvice zastoupeny karcinomy prostaty T2, nebyl zjistěn žadný T4. Teměř 2/3 (60,9 %) karcinomů prostaty bylo dobře diferencovaných. Žadný z pacientů na incidentalni karcinom prostaty nezemřel. Smrt byla ve 12 (52,2 %) připadech na podkladě progredujiciho karcinomu mocoveho měchýře a 1 (4,3 %) pacient zemřel na cevni mozkovou přihodu.

V letech 1996 - 1999 jsme na dětskem odděleni urologicke kliniky FN v Hradci Kralove osetřili dvě devitilete děti (děvce a chlapce) s nadorem dolnich cest mocových.Jednalo se o nador mocoveho měchýře z přechodniho epitelu (papilom). Chlapec byl přijat s masivni hematurii, děvce bylo vysetřeno pro bolesti břicha. Nador byl u obou zjistěn sonograficky, diagnoza potvrzena uretrocystoskopii a nasledným histologickým vysetřenim odebrane tkaně. Lecba spocivala v resekci nadoru. Oba jsou pravidelně kontrolovani. Nemocna je 5 let bez recidivy tumoru, chlapec 6 měsiců.Přestože jsou nadory dolnich cest mocových v prve dekadě života vzacne, je nutno na ně myslet. Pro diagnostiku je rozhodujici uretrocystoskopie s biopsii a histologicke vysetřeni. Epitelialni nadory maji dobrou prognozu, nerecidivuji. Resekce do zdrave tkaně se zda lecebně dostatecna. Nemocni vyžaduji dlouhodobou dispenzarizaci.