摘要
目的探讨前列腺癌不同治疗手段的选择和时机。方法回顾性分析1例局限性高危前列腺癌患者的完整临床资料。患者69岁，因尿频伴排尿困难2年入院。直肠指检：前列腺2。增大，右侧叶质地硬，近前列腺尖部可触及0．8cm结节。血清T—PSA36．8ng/ml。前列腺穿刺活检：右侧叶5针，4／5见癌组织，Gleason评分7分（4＋3）。临床分期：T2bN0M0。结果患者先后接受根治性前列腺切除术、挽救性放疗＋内分泌治疗、阿比特龙、恩杂鲁胺、镭一223临床试验、多西他赛＋泼尼松化疗以及米托蒽醌＋泼尼松化疗，几乎涵盖了目前国内所有的治疗手段。患者从初始治疗到死亡历经57个月。结论对于高危前列腺癌患者，尤其是高龄患者首先推荐根治性放疗＋2～3年的内分泌治疗；对于年轻患者采用根治性前列腺切除＋扩大淋巴结清扫术的多模式治疗是一种肯定的选择。根治性前列腺切除术后伴有高危因素或已出现复发的患者进行术后放疗，能降低生化复发率和提高局部控制率。阿比特龙、恩杂鲁胺和多西他赛＋泼尼松化疗之间顺序的选择，目前还基于患者自身情况、既往治疗史、有无症状以及不良反应等综合考虑决定。
The diagnosis and treatment of localized high-risk prostate cancer： a case report and regimen prescription strategy Wen Li, Shou Jianzhong. Department of Urology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College ,Beijing 100021, China Corresponding author： Shou Jianzhong , Email ： shoujzh @ 126. corn [ Abstract ] Objective To explore the choices and timing of different treatment regimens of prostate cancer. Methods The complete clinical data of one case of localized high-risk prostate cancer was reported. The patient, aged 69 years old, was admitted to hospital with urinary frequency and dysuria for 2 years. Serum total PSA was 36.8ng/ml and prostate biopsy dignosed as prostate cancer. The Gleason score was 4 ＋ 3, and the clinical stage was T2b N0M0. Results The patient underwent radical prostatectomy, salvage radiotherapy ＋ androgen deprivation therapy, abiraterone, enzalutamide, Radium-223, docetaxel ＋ prednisone chemotherapy and mitoxantrone ＋ prednisone chemotherapy, which included almost all of the current domestic treatment regimens. The patient lived for 57 months from the initiation of treatment. Conclusions For the patients with high-risk prostate cancer, especially for elderly patients , they should firstly be recommended the treatment of radical radiotherapy ＋ 2 - 3 years of androgen deprivation therapy. For young patients, radical prostatectomy ＋ extended pelvic lymph node dissection as part of multi-modal therapies is considered to be a positive choice. However, for the patients with risk factors or recurrence after radical prostatectomy, the postoperative radiotherapy should be performed in order to reduce biochemical recurrence and improve local control. Currently, the order of choice of abiraterone, enzalutamide or docetaxel ＋ prednisone chemotherapy, is based on the patient＇s situation, past history of treatment, symptoms, side effects as well as other related clinical features.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第6期461-468,共8页
Chinese Journal of Urology
关键词
前列腺癌
局限性高危
多模式治疗
放疗
Prostatic neoplasms
Localized high-risk
Muhi-modal therapy
Radiotherapy
