晚期超高PSA型前列腺癌的临床特征及诊治分析

发布时间：2018-07-18 17:23

【摘要】：目的探讨晚期血清超高前列腺特异性抗原（prostate specific antigen，PSA）型前列腺癌患者的临床特点和诊疗方法，提高对该类患者的诊疗水平。方法回顾性分析自2009年12月至2014年2月我科收治的28例首诊时血清PSA水平超过500ng/ml的前列腺癌患者的临床资料，分析该类患者的发病年龄、确诊方法、病理结果、治疗方案以及预后，总结该类患者的临床特点，同时取同时期首诊血清PSA低于500ng/ml的前列腺癌患者作为对照组，比较二者的发病年龄、病理结果、治疗方案以及预后等有无差异。结果所有入组的28例患者在确诊后均给予黄体生成素释放激素类似物（LHRH-α）及雄激素拮抗剂等药物行内分泌治疗，其中行“比卡鲁胺片+醋酸戈舍瑞林缓释植入剂”治疗的患者有14例（50%），行“比卡鲁胺片+注射用醋酸亮丙瑞林”治疗的患者有14例（50%），患者应用内分泌药物后其血清睾酮及PSA迅速下降，临床症状缓解；用药后有9例（32.1%）出现ED及性欲丧失症状，结合患者高龄等因素，未予以处理；7例（25%）患者出现面色潮红，1个月后，该类副作用明显减轻；2例(7.1%)出现胰岛素抵抗，建议至内分泌科诊疗，给予口服药物治疗，现患者血糖正常；1例（3.6%）患者出现男性乳房发育，3个月后症状消失。有12例患者同期行125I粒子植入治疗,治疗后10例患者疾病控制可，另外两例疾病进展，分别出现左肾和盆腔淋巴结转移，后给予二者以多西他赛为基础的化疗方案治疗；患者行125I治疗后有5例出现轻至中度的下尿路症状（LUTS）及肛门会阴区不适，有3例出现暂时性的排便习惯改变或里急后重等直肠刺激症状，2例患者在术后前3天内出现直肠出血症状，远期观察未见患者出现尿道狭窄、直肠前列腺瘘等重大不良反应。28例患者中有20例在确诊时即已出现全身多发骨转移现象，该类患者中7例患者行锶（89）治疗，另外13例患者行因卡膦酸二钠治疗。行89锶治疗的患者中只有1例出现原骨骼病灶增大和新发骨骼转移灶，另外6例患者未发现有新发骨骼病变；给予因卡膦酸二钠治疗的13例患者中，有4例患者治疗过程中出现新发骨骼病变，其他9例患者未出现骨骼病变，两种方法相比对骨骼的保护作用没有统计学意义（P＞0.05）。所有患者治疗过程中有18例患者进展为去势抵抗前列腺癌（castrationresistant prostate cancer,CRPC），该类患者从一线内分泌治疗开始至进展为CRPC的时间最长为21个月，最短为7个月，中位时间为13个月。患者进展为CRPC后在坚持行内分泌治疗的同时，有3例患者对新发病灶行外放射治疗后病情稳定，9例患者在给予以多西他赛为基础的行化疗方案治疗，化疗后生存期最短的为2号患者，时间为2个月，最长的为17号患者，生存时间为9个月，化疗过程中2例（7.1%）患者出现粒细胞减少性发热，给予粒细胞集落刺激因子后，症状改善；1例（3.6%）患者化疗起始阶段出现腹泻，对症治疗后症状消失；1例1例（3.6%）患者存在肢体麻木感，化疗后第3~6天，症状消失；余未见其他不良反应。另有6例出现新发骨骼病灶的CRPC患者采用“茵福+89锶”治疗后，，患者病情稳定。本研究随访6~48个月，平均随访17.9个月，21.5%（6例）患者死于前列腺癌所引起的并发症，7.0%（2例）患者死于恶病质，1例（3.6%）患者因肝脏衰竭而死亡，死于心脏衰竭的患者1例（3.6%），1例（3.6%）患者因长期卧床死于坠积性肺炎，1例（3.6%）患者死于心肌梗塞，其余16例截至2014年2月仍在随访中，未见重大不良反应。结论首诊时血清高水平PSA前列腺癌患者临床中较为少见，患者大多高龄，且较早出现骨骼等远处脏器转移，预后差，需行内分泌治疗、放射治疗、化学治疗等综合治疗方法，而早期诊断、早期治疗仍是影响预后及存活的重要因素。
[Abstract]:Objective To study the clinical features and diagnosis and treatment methods of patients with advanced prostate specific antigen ( PSA ) type prostate cancer , and to improve the diagnosis and treatment level of patients with prostate cancer .
There were 9 cases ( 32 . 1 % ) with ED and the symptoms of sexual desire loss after medication , combined with the age of the elderly and other factors , were not treated ;
7 ( 25 % ) patients had facial flushing , and the side effects were significantly reduced after 1 month .
In 2 cases ( 7.1 % ) , insulin resistance was found , and it was suggested to be treated with oral medication and the patient ' s blood glucose was normal .
One ( 3.6 % ) patients developed male breast development , symptoms disappeared after 3 months . 12 patients were treated with 125I seeds at the same time , 10 patients were treated with disease control after treatment . Two other diseases progressed , left kidney and pelvic lymph node metastasis respectively , and both were treated with docetaxel based chemotherapy regimen .
There were 5 cases with mild to moderate lower urinary tract symptoms ( LUTS ) and discomfort in the vaginal area after 125I treatment . There were 3 cases with rectal bleeding symptoms of temporary defecation habit change or internal emergency , and 2 cases had serious adverse reactions such as urethral stricture and rectal prostatic fistula . Among the 28 patients , only 1 case had original bone lesions and new bone metastasis .
Of the 13 patients treated with disodium ocephosphonate , there were 4 patients with new bone lesions in the course of treatment , and other 9 patients had no skeletal lesions , and there were no statistically significant effects on the protection of bone compared to the two methods ( P > 0.05 ) .
In 1 case ( 3.6 % ) , diarrhea occurred in the initial stage of chemotherapy , and the symptoms disappeared after treatment .
1 case ( 3.6 % ) had numbness of limbs , 3 - 6 days after chemotherapy , the symptoms disappeared ;
There were no other adverse reactions . 6 patients with new bone lesions were treated with " Yin Fu + 89 strontium " , and the patients died in the follow - up period of 6 to 48 months . The patients died of myocardial infarction due to liver failure . One patient died of cardiac failure ( 3.6 % ) . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . The prognosis was poor . Early diagnosis was still an important factor affecting the prognosis and survival .
【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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