缓退瘤治疗前列腺癌

1995年5月至1998年8月,用缓退瘤(Flutamide)治疗前列腺癌18例,其中A期1例,B期4例,C期8例,D期5例。病理确诊后14例行手术去势及缓退瘤治疗,4例行药物去势加缓退瘤瘤。B期及C期各1例在接受雄激素全阻断治疗3月后行保留性神经的前列腺癌根治术。15例获得显著效果,1例出现肝功能损害,1例出现Flutaide撤除综合症。2例接受根治术者,术后5月PSA降为0,达到根治目的。     

缓退瘤治疗晚期前列腺癌(附10例报道)

目的：探讨缓退瘤治疗晚期前列腺癌的效果。方法：行去势手术加口服缓退瘤治疗晚期前列腺癌１０例。结果：生存８例,死亡２例。生存者转移灶消失,原发灶缩小。结论：对晚期前列腺癌行去势术加缓退瘤的治疗效果较好。     

缓退瘤治疗前列腺癌：附32例报告

从１９９３年６月至１９９４年１２月，用缓退瘤（ｆｌｕｔａｍｉｄｅ）治疗经组织病理学确诊的前列腺癌病人３２例。确诊后２９例作手术去势，２例药物（ＬＨ－ＲＨ衍生物）去势，１例前列腺膀胱根治性切除＋睾丸切除。３２例中有８例已有１－－４处远隔转移。３１例获得显著效果，１例获得较好效果。副作用有恶心１例，肝功轻微受损减量后恢复正常例，无乳房女性化。     

晚期前列腺癌综合治疗的初步疗效分析

目的 :探讨晚期前列腺癌综合治疗的方法。　方法 :对 1991年 5月～ 1997年 7月收治的 6 2例晚期前列腺癌 (C期和D期 )病人的治疗结果进行分析。 33例前列腺症状评分 (IPSS) <15的前列腺癌病人 (I组 )行去势术 +缓退瘤。 2 9例IPSS≥ 15的病人 (Ⅱ组 )行经尿道前列腺电切 (TURP) +去势术 +缓退瘤。内分泌治疗期间梗阻症状明显加重者再次行TURP。　结果 :治疗后所有病人的主观症状均较治疗前明显改善 ,最大尿流率 (MFR)增加、剩余尿减少、PSA值明显下降。 34例病人在治疗期间 (治疗 16～ 39个月后 )转变为激素非依赖性前列腺癌 ,经停用缓退瘤 ,改用癌腺治或酮康唑治疗 ,17例 (5 0 % )病人得到不同程度的缓解。　结论 :对IPSS≥ 15的晚期前列腺癌病人 ,TURP可有效地减少尿道梗阻所致的并发症 ,配合内分泌治疗效果良好 ,无严重并发症 ;对激素非依赖性前列腺癌 ,停用缓退瘤 ,改用酮康唑或癌腺治治疗 ,可取得一定疗效。     

LHRH-A治疗前列腺癌去势后复发转移疗效的探讨(附5例报告)

作者报告自1994年以来,用LHRH-A治疗前列腺癌做去势术后复发或转移的病人,其中2例为用过缓退瘤(Flutamide)和1例为用过Estramustine控制一时期后复发的病人。5例皆有效,其中4例已控制2年以上。这一事实提示LHRH-A不只是具有“药物去势”作用;去势后促使前列腺癌细胞生长的雄性激素来自肾上腺和其他组织;雄性激素作用于前列腺癌细胞的受体;长期使用LHRH-A起到选择性“药物切除垂体”,达到全雄性激素阻断的作用。建议对LHRH-A在人类前列腺癌治疗作用机制,应作进一步的前瞻性研究。     

完全雄激素阻断治疗晚期前列腺癌的疗效观察

我院对33例晚期前列腺癌患者采取外科去势加术后口服缓退瘤进行完全雄激素阻断治疗，现将治疗及随访结果报告如下。     

89SrCl2在前列腺癌骨转移治疗中的应用

目的观察89SrCl2 在前列腺癌骨转移中的治疗效果.方法前列腺癌骨转移患者38例.89SrCl2 治疗组(25例)采用去势术加缓退瘤加89SrCl2 ,对照组(13例)采用去势术加缓退瘤治疗,分别于治疗前和治疗后3、6个月测定血清PSA,骨扫描,观察骨痛缓解情况.结果89SrCl2 治疗组有效率92%(23/25),对照组31%(4/13),差异有显著性意义(P<0.05).结论89SrCl2治疗前列腺癌骨转移疼痛效果明显,副作用小,且对前列腺癌骨转移灶有治疗作用.     

~(89)SrCl_2在前列腺癌骨转移治疗中的应用

目的　观察89SrCl2 在前列腺癌骨转移中的治疗效果。　方法　前列腺癌骨转移患者38例。89SrCl2 治疗组 (2 5例 )采用去势术加缓退瘤加89SrCl2 ,对照组 (13例 )采用去势术加缓退瘤治疗 ,分别于治疗前和治疗后 3、6个月测定血清PSA ,骨扫描 ,观察骨痛缓解情况。　结果　89SrCl2 治疗组有效率 92 % (2 3/ 2 5 ) ,对照组 31% (4/ 13) ,差异有显著性意义 (P <0 .0 5 )。　结论　89SrCl2 治疗前列腺癌骨转移疼痛效果明显 ,副作用小 ,且对前列腺癌骨转移灶有治疗作用。     

低血清PSA型前列腺癌的回顾性研究

目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。     

氟他胺治疗前列腺癌(附17例报告)

本文报导我院应用抗雄激素药氟他胺治疗前列腺癌17例,其中晚期前列腺癌15例。其即期治疗效果和进口同类产品缓退瘤相比较疗效无差异。认为氟他胺是晚期前列腺癌治疗首选药物。     

Influence of different types of antiandrogens on luteinizing hormone-releasing hormone analogue-induced testosterone surge in patients with metastatic carcinoma of the prostate

The long-term effect of the luteinizing hormone-releasing hormone analogue-induced initial testosterone surge in the treatment of patients with metastatic carcinoma of the prostate still is unknown. However, acute worsening of the disease has been reported in up to 10% of the patients. To prevent such tumor flare we investigated the endocrinological effects of different types of antiandrogens administered in addition to a luteinizing hormone-releasing hormone analogue. Patients with newly diagnosed metastatic prostate cancer were pre-treated with either the steroidal antiandrogen cyproterone acetate (6) or the nonsteroidal antiandrogen flutamide (5) for 1 week before the initial injection of the depot luteinizing hormone-releasing hormone analogue Zoladex. In another 5 patients flutamide was first given 24 hours before Zoladex therapy was started. Luteinizing hormone, testosterone and prostatic acid phosphatase during month 1 of luteinizing hormone-releasing hormone analogue therapy were compared to data obtained in 5 patients treated by Zoladex alone. Only pre-treatment with cyproterone acetate was capable of preventing the Zoladex-induced testosterone surge. However, both pre-treatment regimens with either cyproterone acetate or flutamide for 1 week prevented an initial increase in prostatic acid phosphatase beyond pre-treatment levels in all patients. In contrast, in 4 of 5 patients treated with Zoladex alone and in 2 of 5 pre-treated with flutamide for 1 day an initial increase in prostatic acid phosphatase beyond the pre-treatment values was seen. Our data indicate that pre-treatment with flutamide for only 1 day may not be sufficient to prevent a luteinizing hormone-releasing hormone analogue-induced tumor flare in all cases.     

Flutamide versus stilboestrol in the management of advanced prostatic cancer. A controlled prospective study

In a prospective randomised study the effect of flutamide 750 mg daily was compared with that of stilboestrol 3 mg daily in the treatment of 40 previously untreated patients with advanced prostatic cancer. There was a good subjective response to both treatments. After 12 months, a response was demonstrated in 13 of 20 patients treated with flutamide and 8 of 20 patients treated with stilboestrol. The difference was not statistically significant. Treatment with stilboestrol caused more frequent, and more severe, side effects than flutamide.     

全雄激素阻断治疗晚期前列腺癌

为了评价全雄激素阻断治疗晚期前列腺癌的疗效，采用双侧睾丸切除、Ｆｌｕｔａｍｉｄｅ和Ｆｉｎａｓｔｅｒｉｄ联合治疗Ｄ２期前列腺癌病人５例。随访１５～２０个月，结果ＰＳＡ均正常，前列腺体积缩小６１．２％～６９．３％，有显著性差异（Ｐ＜０．０１），骨转移灶缩小、部分消失，积水肾脏完全恢复正常，所有病人治疗后全部有效。表明全雄激素阻断对晚期前列腺癌有良好的治疗效果。提出在三个层次上阻断雄激素治疗晚期前列腺癌的策略。     

药物去势联合雄激素受体阻断剂治疗晚期前列腺癌(附5年临床观察)

目的 观察药物去势联合雄激素受体阻断剂(氟硝丁酰胺，Flutamide)治疗晚期前列腺癌的疗效及药物去势的稳定性。方法 回顾性分析35例药物去势加雄激素阻断剂治疗晚期前列腺癌的I临床资料。结果 所有病人应用LHRH-A 1个月后血睾酮降至去势水平，持续给药可维持稳定的去势水平。34例有治疗效果，有效率97．1％。经平均38．4月随访，复发率为11．8％。7例出现肝功能异常，15例出现食欲减退，35例出现性欲减退和勃起障碍，2例出现血像异常，16例出现潮热、盗汗。结论 药物去势联合雄激素阻断剂治疗初发的晚期前列腺癌疗效肯定，去势稳定。     

Transrectal ultrasound evaluation of local prostate cancer in patients treated with LHRH agonist and in combination with flutamide.

We followed total prostate and prostatic tumor volumes in patients who received combination endocrine therapy with the antiandrogen flutamide and the LHRH agonist [D-Trp6,des-Gly-NH2(10)]LHRH ethylamide. Twenty-three men with proved prostatic adenocarcinoma (Stages B1 to D2) were subjected to a transrectal ultrasound (TRUS) study before and after a three-month period of combination antihormonal therapy. A total prostatic volume reduction ranging from 17 percent to 70 percent (median 47%, p less than 0.0001) was observed. An even greater effect was observed on tumor volume which was reduced by 20 percent to 91 percent (median 81%, p less than 0.01). After treatment, the original suspicious zone became nonvisible in 4 cases. The TRUS measurements were confirmed by direct examination of the radical prostatectomy specimen in 7 cases. TRUS is thus a precise, sensitive, and valid method for evaluating the effect of combined antihormonal therapy on normal and tumoral prostatic tissues. These data indicate that combination therapy induces a rapid and marked reduction in glandular and tumoral prostatic volume which could well improve the success of radical prostatectomy and increase the changes of cure of localized prostatic cancer.     

晚期前列腺癌的诊断与治疗(附84例报告)

目的提高晚期前列腺癌的诊断和治疗效果。方珐回顾性分析采用睾丸切除术治疗84例晚期前列腺癌患者资料。其中22例行经尿道前列腺电切，3例前列腺癌根治治疗，3例介入化疗。结果78例患者获得3个月至5年随访，1例死亡。46例患者获得5年随访，19例生存。术后患者排尿不畅、尿频、尿急症状改善，下尿道梗阻情况明显缓解，血清前列腺特异性抗原迅速降低，骨痛缓解。结论晚期前列腺癌睾丸切除术和雄激素阻断疗法明显抑制肿瘤生长而延长生命，姑息性经尿道前列腺电汽化术，能解除下尿道梗阻。     

Clinical evaluation of flutamide and estramustine as initial treatment of metastatic carcinoma of prostate

The efficacy and side effects of flutamide were compared with estramustine in patients with advanced prostatic carcinoma. Thirty patients with metastatic cancers but with no serious cardiovascular (CV) conditions were randomly assigned to receive treatment either with flutamide (250 mg X 3) or with estramustine (280 mg X 2). Clinical examination, bone scan, laboratory measurements, including coagulation studies were performed prior to randomization, every three months during year one, and at six-month intervals thereafter. The two groups were comparable with respect to age and tumor characteristics. However, more patients presented with skeletal pain among those later treated with flutamide. During an observation period of between one and two and one-half years, flutamide was discontinued in 1 case (7%) because of icterus, and estramustine in 3 cases (20%) because of CV complications. Of the remaining 14 flutamide-treated patients, 13 responded initially. Eleven of them relapsed, and 5 died of cancer. In the corresponding group of 12 estramustine-treated patients, there were 11 primary responders. Of these, only 2 relapsed and died as did the only nonresponder. The difference between the two groups with regard to relapse is significant (P less than 0.01), but not with regard to mortality. All estramustine-treated patients lost their libido, whereas only 20 per cent of the patients treated with flutamide did so. In the present limited material there was an initial favorable response to flutamide without signs of CV complications and with maintained libido in most cases. However, due to significantly increased risk for relapse compared with estramustine, flutamide cannot be recommended as single therapy except in cases where estrogens are contraindicated or when interference with libido and potency is unacceptable.     

Flutamide therapy for advanced prostatic cancer: a phase II study

A non-steroidal antiandrogen (flutamide) was used to treat 17 patients with advanced prostatic cancer. Twelve of 14 patients who had already failed to respond to conventional hormone therapy were dead within 12 months of starting flutamide therapy and there was a high incidence of side effects. Of three patients who had not received prior hormone therapy, two showed an early partial response and one showed no evidence of response to therapy.