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1. Auflage, 2009

Doctoral Thesis / Dissertation from the year 2009 in the subject Medicine - Neoplasms, Oncology, National & Kapodistrian University of Athens (?????? ??? ????????????? ???????????? ?????? - ?' ?????????? ????????????), language: Modern Greek, abstract: Purpose: To prospectively evaluate the predictive value of various bone formation and resorption makers in patients with bone metastases from prostate cancer after palliative therapies with 186Rhenium-l,l-hydroxyethylidene diphosphonate (186Re-HEDP). Methods: Thirty six males with prostate cancer, suffering from painful osseous metastases and treated with 186Rhenium-HEDP, were studied. None had received therapies that interfere with bone metabolism before 186Rhenium-HEDP therapy and throughout the follow-up period. For each patient, pre-therapy and post-therapy serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), amino-terminal (PINP) and carboxy-terminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxy-terminal (CTx) telopeptides of type I collagen and their combinations were compared to the level and duration of pain response to radionuclide therapies. Results: Pain response was correlated only with pre-treatment values of ??x/PINP, PICP/PINP and NTx/CTx ratios and post-treatment decrease of baseline NTx and PICP values (P=0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to 186Rhenium-HEDP therapies proved post-therapy drop of NTx ?20% (RR=3.44, P=0.0005) and pre-therapy NTx/PINP ?1.2 (RR=3.04, P=0.036) Conclusions: NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from HRPC, who will not respond to palliative treatments with 186Rhenium-HEDP. This information could prevent an inefficient and expensive radionuclide therapy. Also, in the cohort of patients who will eventually undergo such treatments, the middle-term post-therapy changes of NTx offer valuable predictive information regarding long-term palliative response.
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