前列腺偶发癌病理分级与患者生存期的观察

目的：分析良性前列腺增生（BPH）术后，前列腺偶发癌（IDPC）的特点，治疗方法和随访结果．探讨病理分级与治疗方法和患者生存期的关系。方法：回顾性分析1982～2006年因BPH行前列腺摘除术或经尿道前列腺电切术（TURP）1510例资料中发现IDPC68倒，按Mostofi’s分级：Ⅰ级24例，Ⅱ级34例，Ⅲ级10例。睾丸切除术56例。睾丸切除加内分泌治疗48例，单纯内分泌治疗6例，观察等待6例。结果：65例随访1～10年，失访3例，因癌死亡9例，Mostofi’sⅢ级者5例．Ⅱ级者4例，平均生存期分别为20．8个月和28个月。非癌死亡30例，平均生存期52．6个月结论：据国内外文献报告IDPC的发病率逐年增加：IDPC患者术后生存期与病理分级直接相关、本组Mostofi’sⅠ级患者中未发现有因癌死亡者，5年生存期达50．0％，3年生存期达75．0％；Mostofi’sⅢ级患者中5例因癌死亡。5年生存期为0，3年生存期仅为40．0％；Mostofi＇sⅠ级和Ⅱ级患者，其5年生存期分别为3313％和29．0％．3年生存期分别为75．0％和74．2％。IDPC的后继治疗应考虑多种因素，其主要应是患者的病理分级与预期寿命．其次是患者的经济情况和心理因素。睾丸切除术应为首选治疗方法。对Mostofi’sⅢ级和Ⅱ级患者，预期寿命在5年以上者．可争取施行前列腺癌根治术.     

89Sr联合内分泌治疗前列腺癌多发骨转移的临床研究

[目的]探讨^89Sr（^89锶）联合内分泌治疗前列腺癌多发骨转移的疗效。[方法]52例确诊前列腺癌多发骨转移患者,手术去势后随机分为两组：单纯内分泌治疗组20例。口服抗雄激素内分泌治疗;其余32例采用^89Sr联合内分泌治疗。治疗后3个月随访,观察两组镇痛效果、骨转移病灶数目、前列腺特异性抗原（PSA）变化。[结果]20例内分泌治疗患者,15例疼痛缓解,止痛率为75％,骨转移病灶和PSA不同程度下降,PSA下降55．35±18．23ng／ml;32例患者行^89Sr联合内分泌治疗,30例疼痛缓解,止痛率为93．8％,骨转移病灶和PSA明显下降,PSA下降68．77±20．35ng／ml。较单纯内分泌治疗,联合治疗镇痛效果、骨转移病灶数目减少及PSA降低均有显著性意义（P〈0．05）。[结论]对前列腺癌多发骨转移患者,采用^89Sr联合内分泌治疗,可明显提高止痛疗效,减少骨转移病灶数目、缩小病灶范围及降低血清PSA浓度,疗效优于单纯内分泌治疗。     

前列腺癌根治术前的新辅助治疗

目的：评价前列腺癌根治性前列腺切除术前内分泌治疗的作用。方法：患者术前接受3个月(仅1例为6个月)的雄激素最大限度阻断治疗(LHRH类似物加非甾体抗雄激素药物)。结果：31例患者平均随访40．3个月(18～72个月)、治疗后PSA均下降，28例(90．3％)降至0．5ng／ml以下，3例(9．7％)未降至0．5ng／ml，其中2例术后PSA升高和局部复发。治疗后临床分期与治疗前相比降低4例(12．9％)，升高5例(16．1％)。前列腺切缘肿瘤阳性2例(6．5％)。8例(25．8％)术后20．4个月(6～50个月)出现PSA升高，其中6例(19.4％)术后33.2个月(13～59个月)肿瘤复发，1例死亡。结论：经新辅助内分泌治疗，临床分期和前列腺切缘肿瘤的阳性率降低。     

133例巨大肝癌手术切除疗效分析

1973年至1993年间对133例＞10cm的原冀性肝癌行切除术，根治性切除21例，姑息性切除112例。108例随访满5年以上，5年生存率11．1％，行姑息性切除者，生存1年以上17例，术后平均生存7.7个月，其中10例合并行肝动脉、门静脉双重插管化疗．术后平均生存期15．6个月。对如何提高巨大肝癌的手术疗效作了探讨。     

肝外胆管癌的外科治疗与预后关系临床探讨

作者对55例肝外胆管癌的治疗方法与预后的关系进行临床探讨。按Longmire分型，上段、中段、下段胆管癌分别占43．6％、21．8％、346％；有42例得到病理诊断。手术切除11例（26．2％），“减黄”手术30例（胆肠内引流14例，外引流16例），单纯剖腹，PTCD、非手术保守治疗分别为1、6、7例。随访1～62个月，随访率87．3％。平均生存时间10．8±9．7个月；手术切除组生存时间最长（21．4±16．7个月，P＜0．01），生存率最高（P＜005）；胆肠内引流组的生存时间（12．2±6．8个月）和生存率亦明显高于其它各组（P＜0．05）。因此，对有条件的肝外胆管癌，应争取早期作根治性切除＋胆管空肠吻合，并酌情切除受累肝脏；即使无根治条件，亦应尽可能作胆肠内引流。     

89SrCl2治疗前列腺癌骨转移27例疗效分析

目的探讨氯化锶（^89SrCl2）治疗前列腺癌骨转移的疗效。方法采用静脉注射^89SrC2（1．48—2．22MBq/kg体重）治疗27例患者前列腺癌骨转移病灶及疼痛。随访时间6个月。结果^89SrCl2治疗后无效4例（14．8％）；有效16例（59．3％）；显效7例（25．9％）。总有效率为85．2％。部分患者复查骨显像显示，原异常浓聚影明显缩小、减少和／或消失。PSA检查15例（55．5％）较治疗前下降，4例（14．8％）降至20ng／ml以下。70．4％的患者在接受^89SrCl2治疗后，白细胞和血小板计数轻度下降，在3～5个月内恢复到治疗前水平。结论^89SrCl2可以安全、有效地缓解骨转移癌所致疼痛。     

153Sm-EDTMP治疗骨转移癌疼痛的临床应用

目的 探讨钐－乙二胺四甲撑膦酸（^153Sm-EDTMP)治疗骨转移癌疼痛的临床疗效。方法 应用^153Sm-EDTMP治疗82例骨转移癌疼痛患者，根据治疗后疼痛缓解和生活质量的情况判断疗效，同时比较其病灶摄取放射性的变化。结果 治疗后疼痛缓解有效率为74．4％（61／82），其中显效22例（26．8％），有效39例（47．6％），稳定21例（25．6％）。治疗前列腺癌骨转移、乳腺癌骨转移、肺癌骨转移疼痛的有效率分别为80．6％（25／31）、78．9％（15／19）、63．2％（12／19）。结论 应用^153Sm-EDTMP治疗骨转移癌疼痛是1种有效的姑息治疗技术，尤其对前列腺癌和乳腺癌的骨转移疼痛疗效较好，但要注意骨髓抑制。     

晚期胃癌34例治疗经验

目的：探讨晚期胃癌合理的治疗方式。方法：总结34例晚期胃癌治疗经验。21例患者行姑息性切除手术,13例行非切除手术。34例术前腹腔加静脉化疗。术中腹腔温热灌注化疗25例,术后腹腔化疗25例,静脉化疗13例。结果：姑息性手术辅助化疗,患者1、3年生存率为70．6％和5．9％。姑息性手术辅助化疗能延长术后生存时间,21例患者平均生存23个月,最长生存42个月。腹腔灌注化疗毒副反应轻,效果显著。结论：姑息性切除手术在晚期胃癌患者治疗中是可行的,腹腔灌注化疗是较理想的辅助化疗方式。     

放射性核素骨显像联合血清PSA、fPSA、ALP及BAP在评价内分泌疗法治疗前列腺癌

目的 探讨放射性核素骨显像联合前列腺特异性抗原（PSA）、游离前列腺特异性抗原（fPSA）、碱性磷酸酶（ALP）及骨特异性碱性磷酸酶（BAP）在评价内分泌疗法治疗前列腺癌疗效中的应用价值。 方法 选取2016年1月至2017年12月于随州市中心医院接受内分泌疗法治疗的64例前列腺癌患者作为研究对象。接受内分泌治疗后1年，进行PSA、fPSA、ALP、BAP水平检测以及放射性核素骨显像检查，根据检查结果评估放射性核素骨显像在评价前列腺癌内分泌疗法治疗效果中的应用。 结果 内分泌治疗后的64例患者经放射性核素骨显像检查结果显示共发生51例骨转移；放射性核素骨显像转移灶数目＞2个骨转移灶的患者的血清PSA、fPSA水平高于骨转移灶≤2个患者的的血清PSA、fPSA水平（均P＜005）；随着骨显像分型的增高，前列腺癌骨转移患者血清PSA、ALP与BAP水平均增高，呈正相关（均P＜005）。 结论 放射性核素骨显像联合PSA、fPSA、ALP、BAP能够实现内分泌疗效的准确评价与骨转移瘤的早期诊断。     

联合间歇性内分泌与^125Ⅰ放射性粒子植入术治疗局部晚期前列腺癌（附20例报告）

目的：探讨联合^125Ⅰ放射性粒子植入术和间歇性内分泌治疗局部进展期前列腺癌的临床价值。方法：前列腺癌患者20例,年龄52～80岁,中位年龄74岁,PSA：6．83～643．8ng／mL,Gleason Score：7～9分,临床分期T3NOMO.连续硬膜外麻醉,截石位,直肠超声从前列腺基底到尖部进行扫描,图像传送至计算机计划系统进行三维重建和术中计划,根据计划行直肠超声引导下经会阴^125Ⅰ放射性粒子植入术,术后结合雄激素全阻断疗法。当PSA达到0ng／mL,并稳定2个月后停止内分泌治疗,当PSA连续3次上升,则重新开始内分泌治疗。结果：所有患者手术均顺利,术中使用穿刺针26～36根,植入粒子57～99粒,平均73粒。术后随访8～51个月,平均22月。1例术后16个月发生骨转移,1例术后22个月死亡。术后3～5个月所有患者的PSA都降到正常范围,其中3例PSA未达到0ng／mL,未停药。4例术后5～26个月,出现PSA反弹,再次用药3～5个月PSA值达到0ng／mL。目前12例未出现PSA反弹,第一周期脱离治疗时间2～44个月,平均16．9个月。近期出现的并发症有轻至中度尿路刺激症30％（6／20）,急性尿潴留5％（1／20）,直肠刺激症和血便25％（5／20）,多数患者症状随访1年后缓解。目前18例患者的PSA值在0～1．2ng/mL之间,其中17患者PSA≤0．17ng／mL。结论：对于局部晚期前列腺癌,^125Ⅰ放射粒子植入术结合间歇性内分泌是一种安全有效的治疗方法。     

高能聚焦超声联合内分泌及放射治疗前列腺癌

目的观察高能聚焦超声（HIFU）联合内分泌及外放射治疗前列腺癌（PCa）的疗效和副反应。方法 HIFU联合内分泌及外放射治疗PCa63例,其中Ⅱ期12例,Ⅲ期39例,Ⅳ期12例。术前、术后监测PSA、前列腺体积、最大尿流率（Qmax）变化及副反应发生情况。结果 53例获得12～38个月的随访。术后6个月平均PSA显著降低,为23.3±19.8ng/m1（P〈0.01）;术后6个月前列腺体积缩小和Qmax提高,较术前差异有显著性（P〈0.05）;患者l、3年生存率分别为88.9%和65.5%;血尿、尿潴留、尿失禁副反应发生率分别为16.0%、6.0%和3.0%。结论 HIFU联合内分泌及外放射治疗前列腺癌能有效降低PSA,缩小前列腺体积,提高Qmax,且副反应轻微。     

骨转移前列腺癌的临床诊治研究报道

Objective:To summarize the experience of diagnosis and treatment outcomes for bone metastatic prostate cancer.Methods:A retrospective study with a total of 128 prostate cancer(Pca) was performed from 2000 to 2005,in our institute.We analyzed the clinical features and outcomes of patients with bone metastases and the data and follow-up of 63 bone metastases was collected by one registrar.Cochran Armitage trend test was used for statistic analysis and a P-value of < 0.05 was taken as statistically significant.Results:The mean age was 73(range 55 to 87) years.The PSA level was from 0.083 ng/mL to 6462 ng/mL.Bone metastases morbidity had good relationship with PSA level.With the mean follow up of 30(range 6 to 72) months for 52/63(82.5%) patients,15(28.8%) died from Pca with a mean survival of 21 months and 1 patient with PSA less than 4 ng/mL at the time died from cerebrovascular suddenness 6 months post-treatment.Conclusion:The early effect of endocrine treatment for bone metastases is obvious,and palliative prostatectomy is satisfactory and able to improve the quality of life rapidly for patients with obstructive symptoms.     

晚期前列腺癌患者间歇性内分泌治疗的疗效观察

背景与目的：间歇性内分泌治疗是晚期前列腺癌患者的一种新的治疗策略,但该方法的运用仍然存在一定争议。该研究旨在探讨晚期前列腺癌患者行间歇性内分泌治疗的疗效,并对影响疗效的因素进行分析。方法：选取2009年7月—2015年5月间在我院治疗的晚期前列腺癌患者,均先进行6个月的内分泌治疗,然后评估内分泌治疗的疗效,采用随机数表法将对内分泌治疗敏感的患者分为持续治疗组和间歇治疗组,观察两组患者的疗效、患者的生活质量评分及不良反应等指标,并分析影响间歇治疗组患者预后的相关因素。结果：共收治晚期前列腺癌患者128例,经前期内分泌治疗后有96例前列腺特异性抗原(prostate-specific antigen,PSA)明显下降,其中43例患者接受间歇性内分泌治疗,53例患者接受持续性内分泌治疗。间歇组患者治疗间歇期的KPS评分为82.6±7.4,明显高于持续组患者治疗期间的KPS评分(69.8±8.7),两者之间差异有统计学意义(P<0.05)。间歇组患者治疗相关的不良反应发生率、发展成为非激素依赖性的比例均明显低于持续治疗组,差异有统计学意义(P<0.05)。间歇组5年生存率为72.1%,高于持续组的63%,但两者比较差异无统计学意义(P＞0.05)。前期内分泌治疗后的PSA水平及患者治疗前的Gleason评分是患者预后的重要影响因素。间歇组随访13~70个月,患者接受1～4个循环的治疗。随着治疗时间的延长,参与治疗的例数越来越少,两次治疗的间隔也越来越短。结论：间歇性内分泌治疗是一种有效的治疗晚期前列腺癌的方法,疗效满意,安全可靠,能有效改善患者的生活质量,且能使患者的经济负担明显减轻。     

Correlation between re-biopsy one year after endocrine therapy and long-term prognosis in localized prostate cancer

PURPOSE: Even in the cases of localized prostate cancer, there are a substantial number of patients who undergo endocrine therapy, and their prognosis is affected by the treatment. We evaluated the histological effect of endocrine therapy and analyzed its correlation with prognosis. METHODS AND SUBJECTS: Seventy-seven cases with localized prostate cancer who underwent maximal androgen blockade (MAB) therapy 1 year or longer were pathologically evaluated using repeat biopsy specimens from November 1994 to October 2001. The relationship between clinical parameters and histological effect in repeat biopsy specimens was examined. Biopsy was conducted mainly by the 6-site systematic method, and the histological effect was judged in accordance with the General Rules for Clinical and Pathological Study of Prostate Cancer (3rd edition). The median re-biopsy and follow-up periods were 13 months and 41 months, respectively. RESULTS: Using this criteria for the histological effects of anti-cancer treatment, the histological effect of endocrine therapy was most frequently observed in class G3b with 61.0%, and correlations with PSA nadir and initial biopsy positive number before endocrine therapy were observed. After biopsy, radical prostatectomy was performed on 9 patients (endocrine therapy was concurrently performed on 4), endocrine therapy on 67 (intermittent administration on 21), and radiation therapy on 1 (MAB was concurrently performed). Outcomes included PSA failure in 14, of whom 2 died of cancer. Three-year and 5-year PSA-failure free survival rates were 91.1% and 76.3%, respectively. Pathological disease stage in radical prostatectomy specimens was examined by dividing it into class G0-2 and class G0-3. This revealed a significant correlation between histological effect and pathological disease stage (pT2-3). PSA-failure free survival was analyzed in 67 of the 77 patients who underwent endocrine therapy. A significantly large number of PSA-failures occurred in class G0-2. Multivariate analysis revealed that the histological effect alone was the influencing factor in PSA-failure. CONCLUSION: A strong histological effect by MAB 1 year or longer after treatment was observed on localized prostate cancer. Evaluation of the histological effect by the present method was considered to be a useful predictor for organ-confined disease after radical prostatectomy and endocrine therapy for PSA-failure.     

A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months

BACKGROUND: To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. METHODS: One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. RESULTS: Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01). CONCLUSIONS: For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer.     

Urinary levels of vascular endothelial growth factor in patients with prostate cancer as a predictor of disease progression

BACKGROUND: The objectives of this study were to investigate the association between urinary levels of vascular endothelial growth factor (VEGF) and the progression of prostate cancer, and to evaluate changes in urinary VEGF levels before and after initial treatment. MATERIALS AND METHODS: A total of 97 patients with prostate cancer were included in this study. Of these 97, 52 underwent radical prostatectomy and the remaining 45 received hormonal therapy as initial treatment. Urinary VEGF levels were measured using a sandwich enzyme immunoassay, and the results were analyzed with respect to several clinicopathological factors. RESULTS: The mean urinary level of VEGF in patients with prostate cancer was significantly higher than that in healthy controls. The urinary level of VEGF in prostate cancer patients with metastasis was significantly elevated compared with that in those without metastasis. Among 52 patients who underwent radical prostatectomy, the urinary levels of VEGF in patients with pathologically organ-confined disease were significantly lower than that in those with extraprostatic disease. Furthermore, the urinary VEGF level in 52 patients after radical prostatectomy was significantly lower than that before radical prostatectomy, while there was no significant difference in urinary VEGF level in 45 patients before and after hormonal therapy. CONCLUSION: These findings suggest that the elevation of urinary VEGF could be a useful predictor of disease progression in prostate cancer, and that the urinary levels of VEGF reflect the therapeutic effect of radical prostatectomy, but not that of hormonal therapy.     

89例中晚期前列腺癌内分泌治疗临床分析

目的探讨内分泌治疗中晚期前列腺癌的临床疗效以及前列腺特异性抗原（PSA）在临床诊疗中的价值。方法对内分泌治疗的中晚期前列腺癌患者进行随访,并结合临床资料进行分析。结果共随访89例中晚期前列腺癌患者,其中死亡20例,获取完整随访资料者72例,97%患者临床症状得到改善,血清PSA下降[治疗前（106.32±197.66）ng/ml与治疗后3个月（22.35±126.32）ng/ml（t=3.67,P〈0.01）;治疗前与治疗后6个月（36.29±173.00）ng/ml（t=3.50,P〈0.01）;治疗后3个月与治疗后6个月（t=-0.782,P〉0.05）]。结论内分泌治疗可明显控制前列腺癌疾病进展,改善尿路梗阻等症状;PSA在前列腺癌的早期诊断、临床分期、疗效监测及预后判定中可发挥重要作用,对于伴有下尿路梗阻的患者,是否结合经尿道前列腺电切术（TURP）进行治疗,仍然需要进一步探讨。     

Radical prostatectomy for locally advanced primary or recurrent rectal cancer.

AIM: Three papers including five patients have described en bloc radical prostatectomy for locally advanced rectal cancer. METHODS: Six patients (median age 63 years) underwent en bloc radical prostatectomy for locally advanced (3) or recurrent (3) rectal cancer involving the prostate. Quality of life questionnaires were answered postoperatively and the data prospectively entered in a database. RESULTS: One primary case had low anterior resection (LAR), the others abdominoperineal resections (APR) of R0 stage. Two recurrent cases had APRs and one tumour resection-all R1 stage. Anastomotic leakage led to construction of an ileal conduit in one patient and in two healed on conservative treatment. Follow up was 10-50 months. One patient died from distant metastases at 29 months postoperatively, one was operated for a single lung metastasis and one has disseminated lung metastases. None has developed local recurrence. Four of the five with anastomoses had good quality of life and none wanted an ileal conduit. CONCLUSION: In spite of a relatively high urinary leak rate the total complication rate seems to be lower than after pelvic exenteration. En bloc radical prostatectomy seems an option in selected patients otherwise needing pelvic exenteration for locally advanced or recurrent rectal cancer.     

前列腺偶发癌20例报告

目的:分析前列腺增生术后前列腺偶发癌的检出方法、治疗及结果。方法:回顾性分析1990年～2006年601例BPH行前列腺摘除和TUVP治疗后检出偶发癌20例患者的临床资料,年龄55岁～76岁。病理全部为腺癌,A1期16例,A2期4例。治疗15例。结果:随访1月～5年,2例A2期死亡,其中1例未治疗,余13例未见恶化。结论:应用PSA检查后前列腺偶发癌检出率下降,TUVP可能影响检出率。     

A case of hormone/docetaxel-refractory prostate cancer in which PSA level decreased after docetaxel+zoledronic acid treatment

The patient was a 63-year-old man who had a recurrence and bone metastasis of prostate cancer after total prostatectomy. He was diagnosed with prostate cancer refractory to hormones. Subsequently, the PSA level decreased after docetaxel therapy, but then gradually increased. Thus, he was diagnosed with bone metastasis of prostate cancer refractory to therapy with hormones or docetaxel. The PSA level decreased after the start of therapy with docetaxel+ zoledronic acid. Zoledronic acid seems to be effective not only for the prevention but also for the treatment of skeletal related events(SRE)in patients with prostate cancer with bone metastases.