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INT. J. IMMUNOTHERAPY XIX(2-4) 41-45 (2003)
UKRAIN IN THE TREATMENT OF PROSTATE CANCER PATIENTS
Villa Medica Clinic, Edenkoben, Germany.
Summary: Ukrain is a semisynthetic drug with high anticancer activity. A total of 74 patients with different stagesof prostate cancer were treated in our clinic during the period from September 1997 to January 2003. In allpatients, metastases into bones and lymphatic nodes were present. Ukrain dosage was 0.3 mg/kg body weightthree times a week. Regional hyperthermia at 13.56 MHz was delivered to metastatic tumors in bones and lym-phatic nodes, leading to the increase of local temperature to more than 42.5 °C. Analgesics were prescribedaccording to the World Health Organizations (WHO) Analgesic Ladder. Effectiveness of treatment was estimat-ed according to the standard complex of diagnostic measurements: digital rectal examination, ultrasonography,and prostate-specific antigen (PSA) detection. According to the results of treatment, 54 patients (73%) werecompletely free of cancer. Taking into account the presence of patients with high Gleason scores and the fail-ure of standard treatment, this exceeds the response rate of all existing methods of prostate cancer treatment.
sia, accounting for 29% of such deaths (1, 2). In Ger-many in 2001, 10,483 men died from prostate cancer.
Despite the development of various fresh ap-
Carcinoma of the prostate is predominantly a tumor
proaches to the treatment of prostate carcinoma, this
found in older men, which frequently responds to treat-
disease remains one of the major problems in mod-
ment even when widespread and may be cured when
ern oncology. In the USA in 1999 more than 179,000
localized. The median age of patients at diagnosis is
new cases of this disease were recorded, and 37,000
72 years, although the number of patients under 60
patients died from it. In the USA, this malignancy is
the most frequent cancer in men, and the second
Definitive treatment is usually considered for young-
most common cause of male mortality from neopla-
er patients without any concomitant illnesses, sinceyounger men are more likely to die of prostate cancer
Address for correspondence: B. Aschhoff, Villa Medica
than older ones or those with major comorbidity.
Clinic, Klosterstrasse 179, D 67480 Edenkoben, Germany.
Few prognostic markers are available. Elevations
of serum acid phosphatase have been associated in
some trials with poor prognosis in both localized and
disseminated disease. However, prostate-specific anti-
In a large case series of men who underwent the
gen (PSA), an organ-specific marker with greater sen-
anatomic (nerve-sparing) procedure of radical pro-
sitivity and high specificity for prostate tissue, is most
statectomy, only about 6% subsequently required the
often used both for diagnosis and to monitor response
use of pads for urinary incontinence, but an unknown
to treatment. After radical prostatectomy, detectable
additional proportion had occasional urinary dribbl-
PSA levels identify patients at elevated risk of local
ing. About 40-65% of men who were sexually potent
treatment failure or metastatic disease; however, a
before surgery retained potency adequate for vaginal
substantial proportion of patients with elevated or ris-
penetration and sexual intercourse. Preservation of
ing PSA levels after surgery may remain clinically free
potency was dependent on tumor stage and patient
of symptoms for extended periods of time.
age, but the procedure probably induces at least par-
After radiation therapy with curative intent, persis-
tial deficit in nearly all patients (6).
tently elevated or rising PSA may be a prognostic fac-
A cross-sectional survey of prostate cancer pa-
tor for clinical disease recurrence. However, reported
tients who had been treated in a managed care set-
case series have used a variety of definitions of in-
ting by radical prostatectomy, radiation or watchful wait-
ing, showed substantial sexual and urinary dysfunc-
After hormonal therapy, reduction of PSA to unde-
tectable levels is associated with a longer duration of
Radical prostatectomy may also cause fecal in-
progression-free status. However, decreases in PSA of
continence, and the incidence may vary with surgical
less than 80% may not be very predictive (3). Further-
more, since PSA expression is itself under hormonal
External beam radiation therapy can result in acute
control, androgen-deprivation therapy can decreasethe serum level of PSA, independent of tumor re-
cystitis, proctitis and sometimes enteritis (9-11). These
sponse. Hence clinicians cannot rely solely on serum
conditions are generally reversible but may be chron-
PSA levels to monitor patient response to hormone
ic, although they rarely require surgical intervention.
therapy, and clinical criteria must also be followed (4).
A cross-sectional survey of prostate cancer patients
Nowadays, patient and doctor can choose from
who had been treated in a managed care setting by
various modes of treatment: surgery (radical prosta-
radical prostatectomy, radiation or watchful waiting
tectomy), external beam radiation therapy, interstitial
showed substantial sexual and urinary dysfunction in
brachy therapy, cryosurgery, hormone therapy or com-
binations of these. With all of these interventions, var-
Radiation therapy can be delivered after extra-
peritoneal lymph node dissection without increased
Complications of radical prostatectomy can include
complications if careful attention is paid to the radia-
urinary incontinence, urethral stricture, impotence and
tion technique. The treatment field should not include
the morbidity associated with general anesthesia and
the dissected pelvic nodes. Previous transurethral
a major surgical procedure. An analysis of Medicare
resection of the prostate (TURP) increases the risk of
records of 101,604 radical prostatectomies per-
stricture above that seen with radiation alone, but if
formed from 1991 to 1994 showed a 30-day opera-
radiation is delayed 4 to 6 weeks after TURP then the
tive mortality rate of 0.54%, a rehospitalization rate of
risk of stricture can be minimized (12).
4.5% and a major complication rate of 28.6%. Over
A prospective community-based cohort of men
the study period, these rates decreased by 30%, 8%
aged 55 to 74 years treated with radical prostatecto-
my (n = 1,156) or external beam radiation therapy
Ukrain in the treatment of prostate cancer patients
(n = 435) sought to compare acute and chronic com-
plications of the two treatment strategies after adjust-ing for baseline differences in patient characteristics
A total of 74 patients with different stages of pro-
and underlying health (13). Regarding acute treat-
state cancer were treated in our clinic during the peri-
ment-related morbidity, radical prostatectomy was
od from September 1997 to January 2003. Charac-
associated with higher rates of cardiopulmonary com-
teristics of the patients are presented in Tables I and
plications (5.5% versus 1.9%), as well as the need for
II. In all patients, metastases into bones and lym-
treatment for urinary strictures (17.4% versus 7.2%).
Radiation therapy was associated with higher rates of
Dosage of Ukrain (Nowicky Pharma, Vienna, Aus-
acute proctitis (18.7% versus 1.6%). With regard to
tria) was 0.3 mg/kg body weight intravenously three
chronic treatmentrelated morbidity, radical prostate-
times a week. Regional hyperthermia, using hyper-
ctomy was associated with higher rates of urinary in-
thermia device Oncocare (Bruker, Wissenbourg,
continence (9.6% versus 3.5%) and impotence (80%
France) at 13.56 MHz, was delivered to metastatic
versus 62%). Radiation therapy was associated with
tumors in bones and lymphatic nodes, leading to the
slightly higher rates of deterioration in bowel function.
increase of local temperature to more than 42.5 °C.
Several different hormonal approaches can ben-
When required, analgesics were prescribed accord-
efit men in various stages of prostate cancer. Com-
ing to the World Health Organizations (WHO)
plications of approaches such as orchiectomy, estro-
gen therapy, luteinizing hormone-releasing hormone
Effectiveness of treatment was estimated accord-
(LHRH) agonists, antiandrogens, ketoconazole and
ing to the traditional complex of diagnostic measure-
aminoglutethimide include psychological effects, loss
ments: digital rectal examination, ultrasonography
of libido, impotence, hot flashes, gynecomastia, pru-
(Sinoline SL-200, Siemens, Erlangen, Germany) and
ritus, onychodystrophy, osteoporosis and adrenalinsufficiency (14-17).
prostate-specific antigen (PSA) detection (Biomeda
In summary, standard therapies for prostate can-
PSA Detection Kit, Foster City, CA, USA).
cer often lower the health-related quality of life. It is
Ukrain was prescribed according to Article 73 of
also worth noting that many geriatric patients, in par-
the German Medicine Law, and all the patients con-
ticular those with localized tumors, may die of other
illnesses without ever having suffered significant dis-ability from their cancer (18).
These considerations prompted us to seek alter-
Table I Duration of diagnosed prostatic cancer in years
native methods of treatment for prostate cancer pa-
Duration of cancer (years) Number of patients
tients. Ukrain, a derivative of alkaloids from greater
celandine and thiophosphoric acid and known for its
excellent anticancer action, was successfully used in
our clinic in the treatment of patients with different
stages of cancer of various localizations (19). In the
treatment of prostate cancer patients, we combined
Table II Grading of patients according to Gleason score
exceeds the response rate of all existing methods of
The outcomes observed in this study could not
have been predicted on the basis of standard anti-cancer therapies. Furthermore, established therapies
for prostate cancer are associated with numerousside effects that often worsen patients quality of life
Ukrain was well tolerated in all cases. Some pa-
more severely than the reason for their indication. In
tients experienced analgesic effects, and opioid dosage
addition, the need to remain in the hospital duringsuch therapy cannot be thought to improve the psy-
was reduced or discontinued. Many patients experi-
chological status of patients. Both these side effects
enced subjective and objective phenomena such as
were avoided here. Quality of life improved in all pa-
headache, vertigo, thirst, sweating, increased urine
tients who received Ukrain, even in those with tumor
production, fever, and pain in tumor and metastases
recurrence and in those whose tumor did not respond
sites. Some patients reported feelings of warmth and
to the therapy. In addition, the therapy could be per-
heat, especially in the areas of malignancy, with flu-
formed on outpatient basis, allowing patients to work
like symptoms. Patients general condition was ame-
liorated in most cases, with normalization of appetite
We did not investigate deep mechanisms of pos-
and improvement in quality of life. Patients whose
sible molecular and cellular action of Ukrain and re-
tumors did not respond, or responded only weakly, to
gional hyperthermia in our patients. From the results
Ukrain therapy had no feeling of warmth, heat or pain
observed, we can suppose that at least some of the
previously reported properties of the drug were dis-
According to the results of treatment (Table III), 54
played: antiangiogenic activity, stimulation of mitotic
patients (73%) had complete remission. Taking into
block in G2/M phase, inhibition of monomeric tubulin
account the presence of patients with high Gleason
polymerization, stimulation of the antitumor activity of
scores and the failure of standard treatment, this
macrophages and improvement in the immune sta-tus of the cancer patient.
Table III Results of the treatment of patients with Ukrain and localhyperthermia
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