Journal of Clinical Oncology, Vol 7, 590-597, Copyright © 1989 by American Society of Clinical Oncology
Treatment of metastatic prostatic cancer with low-dose prednisone: evaluation of pain and quality of life as pragmatic indices of response
I Tannock, M Gospodarowicz, W Meakin, T Panzarella, L Stewart and W Rider
Princess Margaret Hospital, Toronto, Ontario, Canada.
Thirty-seven men with symptomatic bone metastases from prostate cancer that
had progressed following earlier treatment with estrogens and/or
orchidectomy were treated with low-dose prednisone (7.5 to 10 mg daily).
The rationale for this treatment was that some patients might still have
hormone-sensitive disease that was stimulated by weak androgens of adrenal
origin, and that these androgens could be suppressed by prednisone through
its negative feedback on secretion of adrenocorticotrophic hormone (ACTH).
Response to treatment was assessed by requirement for analgesics, by the
McGill-Melzack pain questionnaire, and by a series of 17 linear analog
self-assessment (LASA) scales relating to pain and to various aspects of
quality of life. Fourteen patients (38%) had improvement in indices used to
assess pain at 1 month after starting prednisone, and seven patients (19%)
maintained this improvement for 3 to 30 months (median, 4 months).
Reduction in pain was associated with improvement in other dimensions of
quality of life, and in the scale for overall well-being. Prednisone
treatment led to a decrease in the concentration of serum testosterone in
seven of nine patients where it was not initially suppressed below 2
nmol/L, and caused a decrease in serum levels of androstenedione and
dehydroepiandrosterone sulfate in more than 50% of patients. Symptomatic
response was associated with a decrease in serum concentration of adrenal
androgens. We conclude that (1) low-dose prednisone may cause useful relief
of pain in some patients with advanced prostatic cancer; (2) relief of pain
was associated with suppression of adrenal androgens; and (3) measures of
pain and quality of life can be used to assess possible benefits of
systemic therapy in patients with metastatic prostate cancer.
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