晚期前列腺癌的间歇雄激素阻断治疗

目的：了解间歇雄激素阻断（IAD）方法对晚期前列腺癌的治疗作用。方法：回顾性分析21例晚期前列腺癌病人,应用药物诺雷德去势加氟他胺（甲组）或康士得IAD方法（乙组）治疗的结果。结果：21例患者经IAD治疗后,绝大多数取得了较好的疗效。甲组3年生存率为72．7％,乙组为80．0％,总3年生存率为76．2％。治疗间歇中减少了抗激素药物的应用,从而明显减少了潮红、体重增加及忧郁等内分泌治疗的副作用。结论：IAD治疗能推迟雄激素依赖性前列腺癌细胞向非依赖性细胞的转化,同时减少药物用量和毒副作用,明显改善患者的生活质量并降低治疗费用。     

前列腺癌雄激素剥夺治疗后代谢异常

前列腺癌是老年男性最常见的泌尿系统恶性肿瘤之一,近年来在国内发病率迅速升高.目前绝大多数前列腺癌患者接受雄激素剥夺治疗,但雄激素剥夺治疗引起的代谢异常,如代谢综合征等,已成为影响患者生活质量和生存率的重要因素.     

高危组前列腺癌根治术后雄激素剥夺治疗联合早期放射治疗对局部控制及近期生存率的影响

目的 探讨内分泌治疗合并早期放射治疗对高危前列腺癌患者根治术后的局部控制及近期生存率的影响。方法 收集首都医科大学附属北京朝阳医院14例高危组前列腺癌根治术后行三维适形放射治疗(three dimension-conformal radiotherapy, 3D-CRT)或调强放射治疗(intensive modulation radiotherapy, IMRT)联合内分泌治疗的患者,收集患者基本信息、手术信息,并随访放射治疗期间的相关合并症、术后及放射治疗后前列腺特异性抗原(prostate specific antigen,PSA)变化与生存状态,并进行统计学分析。结果 14例患者治疗后随访时间2~52个月,平均随访时间20个月。在放射治疗疗期间,5例患者出现轻度尿频、尿急,2例出现轻度腹泻、腹胀,1例患者出现白细胞一过性降低,血红蛋白、血小板无异常,无其他合并症发生;1例患者放射治疗疗后24个月,PSA由最低0.056 ng/mL升高至6 ng/mL,但无明显局部复发和远处转移迹象,恢复比卡鲁胺及亮丙瑞林治疗5个月后,PSA降至1.539 ng/mL。其他13例患者无生化指标反弹及临床局部复发。结论 高危前列腺癌根治术后,早期辅助放射治疗联合内分泌治疗可以改善患者局部控制及近期生存率。     

前列腺癌患者去势治疗后心理障碍的原因分析及干预策略

去势治疗是晚期前列腺癌患者首选的治疗方法,但其大大降低了患者的生活质量,易使患者陷入自我形象紊乱、自卑、焦虑、恐惧、多疑、疲劳、情绪低落以及抑郁等多种心理障碍,而心理干预是治疗其心理创伤的有效手段。护理人员作为与患者接触最为频繁的群体应了解患者不同时期的心理问题,分析产生的原因,掌握有效的心理干预手段,为患者提供优质的心理护理服务,提高患者的生活质量。该文就前列腺癌患者接受去势治疗后易产生心理障碍的原因及相应的护理干预措施进行综述,为护理人员进行有效的心理干预提供帮助。     

Survival following primary androgen deprivation therapy among men with localized prostate cancer

Context  Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer. Objective  To evaluate the association between PADT and survival in elderly men with localized prostate cancer. Design, Setting, and Patients  A population-based cohort study of 19 271 men aged 66 years or older receiving Medicare who did not receive definitive local therapy for clinical stage T1-T2 prostate cancer. These patients were diagnosed in 1992-2002 within predefined US geographical areas, with follow-up through December 31, 2006, for all-cause mortality and through December 31, 2004, for prostate cancer–specific mortality. Instrumental variable analysis was used to address potential biases associated with unmeasured confounding variables. Main Outcome Measures  Prostate cancer–specific survival and overall survival. Results  Among patients with localized prostate cancer (median age, 77 years), 7867 (41%) received PADT, and 11 404 were treated with conservative management, not including PADT. During the follow-up period, there were 1560 prostate cancer deaths and 11 045 deaths from all causes. Primary androgen deprivation therapy was associated with lower 10-year prostate cancer–specific survival (80.1% vs 82.6%; hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.03-1.33) and no increase in 10-year overall survival (30.2% vs 30.3%; HR, 1.00; 95% CI, 0.96-1.05) compared with conservative management. However, in a prespecified subset analysis, PADT use in men with poorly differentiated cancer was associated with improved prostate cancer–specific survival (59.8% vs 54.3%; HR, 0.84; 95% CI, 0.70-1.00; P = .049) but not overall survival (17.3% vs 15.3%; HR, 0.92; 95% CI, 0.84-1.01). Conclusion  Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management.      

去势抵抗性前列腺癌进展时间的预测因素分析

目的：探索前列腺癌经内分泌治疗后进入去势抵抗性前列腺癌（castration-resistant prostate cancer, CRPC）的预测因素,以更好地指导临床和提高患者预后。方法：回顾性分析了2003年1月至2014年12月在北京大学第一医院泌尿外科确诊前列腺癌并且初始治疗为内分泌治疗的患者共185例,收集并整理分析的临床信息包括患者年龄、前列腺癌TNM分期、前列腺癌病理Gleason评分（Gleason score, GS)、前列腺癌危险度、内分泌治疗开始时前列腺特异性抗原（prostate-specific antigen, PSA）水平、经过内分泌治疗后的PSA最低值、PSA下降速率以及降到PSA最低值的时间。应用Kaplan-Meier生存分析和log-rank检验比较不同分组间CRPC进展时间的差异,应用Cox风险比例回归模型来分析评估这些因素对CRPC进展时间的影响。结果：185例患者平均年龄(71.02±8.67)岁,CRPC进展的中位时间为38个月（4~158个月）。单因素分析中,前列腺癌T分期、N分期、前列腺癌危险度、内分泌治疗前是否发生远处转移、PSA下降速率和PSA最低值均与CRPC进展时间显著相关（P值均小于0.01）。在多因素分析中,内分泌治疗前已发生远处转移（HR=6.030,95% CI：3.229~11.263,P=0.001）、较高的PSA最低值（HR=1.185,95% CI：1.080~1.301,P=0.001）、PSA下降速率>11 μg/(L·month)（HR=2.124,95% CI：1.195~3.750,P=0.001）以及到达PSA最低值的时间≤9个月（HR=3.623,95% CI：1.640~4.817,P=0.004）均是CRPC进展时间较短的危险因素。结论：前列腺癌患者经过内分泌治疗后,PSA下降速率越快,进入CRPC时间越短。     

Metabolic syndrome and androgen deprivation therapy in metabolic complications of prostate cancer patients

Background  Incidence of prostate cancer in Chinese males grows significantly in the past decades. Androgen deprivation therapy has been generally employed in the treatment of locally advanced and metastatic prostate cancer for many years, yet only little data was known about the metabolic syndrome in patients receiving hormonal therapy. This study described the prevalence and the changing trends of hormone-related metabolic complications, and analyzed their correlation with different therapies.

Methods  In 125 patients treated with castration or maximal androgen blockage for at least 12 months, metabolic indicators were analyzed.

Results  Totally, 13.5% patients in castration group and 30.1% patients in maximal androgen blockage group were diagnosed metabolic syndrome 12 months after the beginning of treatments (χ²=4.739, P=0.029). In castration group, increased triglyceride and decreased high-density lipoprotein-cholesterol were significant at the month 12, increased fasting plasma glucose and blood pressure were significant at the month 4. In maximal androgen blockage group, increased triglyceride and decreased high-density lipoprotein-cholesterol were significant at the month 4, increased fasting plasma glucose and blood pressure were significant at the month 8. Total testosterone and free testosterone in maximal androgen blockage group were significantly lower than castration group at all visits, which were proved to show positive or negative correlations with metabolic indications. Severity of metabolic complications in maximal androgen blockage group was generally more serious than people received castration, with significantly statistical difference or not. Trends of high-density lipoprotein-cholesterol and fasting plasma glucose were significant different between two kinds of therapy (P=0.005, P=0.019, respectively).

Conclusions  Prostate cancer patients receiving androgen deprivation therapy were at high risk of suffering metabolic syndrome. Severity of metabolic complications under different hormonal therapies were not completely consistent, suggested that androgen deprivation therapy may be individualized.

     

Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy

Androgen deprivation therapy (ADT) in men with prostate cancer increases the risk of osteoporotic fractures, type 2 diabetes and, possibly, cardiovascular events. There is considerable uncertainty about the risk-benefit ratio of ADT in non-palliative treatment; the benefits of ADT in treating non-metastatic prostate cancer need to be carefully weighed against the risks of ADT-induced adverse events. Baseline assessment of bone health at the initiation of ADT should include measurement of bone mineral density (BMD) by dual energy x-ray absorptiometry and, in men with osteopaenia, a thoracolumbar spine x-ray. General measures to prevent bone loss, including regular physical activity, as well as ensuring calcium and vitamin D sufficiency, should be instituted routinely. All men with a previous minimal trauma fracture should receive pharmacological therapy unless contraindicated; for those who have not sustained a minimal trauma fracture, treatment is advised if the BMD T score is ≤ - 2.0, or if the 10-year risk of a major osteoporotic fracture exceeds 20%. Men with prostate cancer who are receiving ADT should be closely monitored for weight gain and diabetes; intensive lifestyle intervention is recommended to prevent ADT-induced weight gain and insulin resistance. Management of the metabolic sequelae of ADT includes optimal reduction of cardiovascular risk factors, with particular attention to weight, blood pressure, lipid profile, smoking cessation, and glycaemic control.     

47例前列腺癌药物去势治疗后对生活质量影响的调查

目的 :调查药物去势治疗 (AndrogenDeprivationTherapy ,ADT)对前列腺癌患者生活质量的影响。方法 :自 1998年 3月至2 0 0 3年 1月 ,对门诊或住院的 5 6例初诊为前列腺癌的男性患者进行药物ADT前以及半年后的健康相关生活质量和特殊疾病的生活质量和功能状况进行问卷式调查。结果 :5 6例患者中 ,共 47例完成了药物ADT前后生活质量的调查 ,47例中躯体疼痛等身体不适、因身体健康或情感健康等因素所致在社会或家庭中的日常活动受限情况以及泌尿道梗阻症状均无显著变化 (P >0 .0 5 )。但药物ADT后 ,患者的精神疲软、四肢乏力和食欲不振等症状较前显著增加 ( χ2 =4.77,P <0 .0 5 ) ,全身健康情况 ( χ2 =3 .89,P <0 .0 5 )以及勃起功能 ( χ2 =6.2 7,P <0 .0 5 ) ,性欲 ( χ2 =18.95 ,P <0 .0 1)和勃起并能够完成性生活的能力 ( χ2 =19.0 8,P <0 .0 1)均较前显著减退。结论 :药物ADT后对健康相关的生活质量具有一定的影响 ,尤其在药物ADT后的半年中 ,患者的性功能明显减退。因此 ,在实施药物ADT前向患者说明该项治疗措施对其今后至少半年内的生活质量 ,尤其是性功能方面可造成一定的影响     

超声图像引导定义前列腺癌调强放疗的计划靶区

目的分析超声图像引导摆位系统(B mode acquisition and targeting,BAT)辅助前列腺癌调强放疗时等中心摆位误差,定义无影像引导下前列腺癌调强放疗计划靶区(PTV)的边界。材料和方法选择10例前列腺癌患者每日应用BAT引导摆位进行调强放疗,记录每次等中心前后(AP)、左右和头脚方向上移位的偏差,共255次。采用Kolmogorov-Smimov方法分析检验所获得的数据。结果 BAT验证后等中心移位在左右方向为(3.56±2.71)mm,前后方向(4.08±3.99)mm,头脚方向(3.20±2.92)mm。各个方向上的偏差符合正态分布(RL P=0.806,AP P=0.0.061,SI P=0.106)。在没有图像引导前列腺癌调强放疗摆位的情况下,为满足95%的等剂量曲线覆盖90%患者的CTV,PTV边界需在左右方向向右扩大8.97 mm,向左1.87 mm,前后方向向前需扩大12.05 mm,向后3.91 mm,头脚方向向头侧扩大9.06 mm,向脚侧扩大2.66 mm。结论超声图像引导摆位操作简便,无辐射,系统误差小,可实时纠正。     

晚期前列腺癌的内分泌及放射治疗探讨

目的 探讨晚期前列腺癌的内分泌及放射治疗。方法 回顾性分析61例前列腺癌患者的临床资料。结果 57例行双侧睾丸切除并口服抗雄激素药物,1例药物去势,1例服已烯雌酚,2例放射治疗。7例骨转移者同时行内放射治疗。结论 双侧睾丸切除加雄激素抑制剂并配合内放射治疗是晚期前列腺癌的主要治疗手段。     

护理干预对前列腺癌去势治疗心理障碍和生活质量的影响

目的:探讨护理干预对前列腺癌患者心理状况和生活质量的影响。方法:选择60例前列腺癌去势治疗患者,随机分为常规护理对照组和罗伊-纽曼综合模式护理干预组;采用"Zung焦虑自评量表(SAS)"和"Zung抑郁自评量表(SDS)"进行心理障碍评估,采用(Quality of life,QL)对患者生活质量评分。结果:3个月后干预组患者心理障碍、生活质量明显改善(P<0.05)。结论:罗伊-纽曼综合模式护理干预能改善前列腺癌去势治疗患者的心理障碍,提高患者生活质量。     

Expression change of nuclear receptor corepressor （NCoR） in androgen independence prostate cancer and its clinical significance

Objective：To explore the expression of nuclear receptor corepressor （NCoR） in androgen independence prostate cancer （AIPC） and its clinical significance. Methods：The expression of NCoR and androgen receptor （AR） in prostatie tissues, from 15 cases with AIPC, 20 cases with androgen dependence prostate cancer （ADPC） and 20 cases with benign prostatic hyperplasia （BPH）, was detected by immunohistoehemistry respectively. Results：The expression of NCoR was observed mainly in the nucleus and slightly in the nucleus. The positive cell percentage of NCoR in AIPC was significantly lower than that in ADPC and BPH （P〈0. 01）. The NCoR expression was significantly lower in low differentiation prostate cancer （Pca） than that in high differentiation Pca （P〈0. 05）. The rate of NCoR expression was significantly higher in low stage Pca than that in high stage Pca （P〈0. 05）. AR, expressing in the nucleus, was found to be negative in one case of AIPC, while was strongly expressed in other cases of AIPC, and all eases of ADPC and BPH. Conclusion： The transition to AIPC of Pea may be correlated with the decrease of NCoR protein.     

基于认知行为疗法的院外护理干预对单纯雄激素剥夺治疗的前列腺癌患者影响

目的 研究基于认知行为疗法(CBT)的院外护理干预对单纯雄激素剥夺治疗的老年前列腺癌患者跌倒风险的影响,为提高此类患者的护理质量提供临床依据。方法 将2018年10月至2019年10月我院符合纳入标准的120例诊断为前列腺癌并行单纯雄激素剥夺治疗的患者,随机分成观察组与对照组,每组各60例,对照组患者给予常规护理;观察组患者在常规护理基础上,实施基于CBT的院外护理干预。出院12周后,采用Herth希望量表了解两组患者的希望水平。采用Berg平衡量表观察两组患者的平衡情况以判断其跌倒风险;采用生活质量评价量表SF-36了解两组患者的生活质量情况;采用自制满意度问卷调查表比较两组患者对护理质量的满意度。结果 观察组患者的希望水平、平衡功能、生活质量评分及对护理工作的满意度均高于对照组,差异有统计学意义(P0.05)。结论 对离院后单纯雄激素剥夺治疗的老年前列腺癌患者进行基于CBT的院外护理干预,可以减少患者的负面情绪,提高希望水平和生活质量,有效降低跌倒的发生风险,提高患者对护理质量的满意度,值得在临床工作中推广应用。     

Complete androgen blockade vs. medical castration alone as adjuvant androgen deprivation therapy for prostate cancer patients following radical prostatectomy: a retrospective cohort study

Background: Till date, the optimal treatment strategy for delivering adjuvant androgen deprivation therapy (ADT) in localized and locally advanced prostate cancer (PCa), as a lower stage in PCa progression compared with metastatic PCa, is still unclear. This study compares the efficacy of castration alone with complete androgen blockade (CAB) as adjuvant ADT in patients with localized and locally advanced PCa undergoing radical prostatectomy (RP).Methods: Patients diagnosed with PCa, without lym...     

常规剂量比卡鲁胺治疗雄激素非依赖性前列腺癌（附44例报告）

 目的 探讨采用常规剂量比卡鲁胺（50 mg/d）治疗我国雄激素非依赖性前列腺癌（androgen independent prostate cancer,AIPCa）患者的疗效。方法 遴选AIPCa患者44例,采用常规剂量比卡鲁胺（50 mg/d）进行二线内分泌治疗。以血清前列腺抗原（prostate-specific antigen,PSA）作为主要疗效评估指标,PSA下降≥50%为治疗有效,同时观察治疗的不良反应。结果 常规剂量比卡鲁胺耐受性良好,未发生严重不良反应。PSA总有效率为38.6%（17/44）,中位有效时间5个月。治疗前出现氟他胺撤除综合征（flutaminde withdrawl syndrome,FWS）者以及入组PSA水平较低者（≤20 ng/mL）,有效率高于无氟他胺撤除综合征者和PSA较高者（64.7% vs. 7.4%,61.1% vs. 23.1%）。另外,Kaplan-Meier生存分析显示,无氟他胺撤除综合征者和入组PSA水平较高者（＞20 ng/mL）具有较高的死亡风险度（P=0.044 9,0.025 2）。结论 常规剂量比卡鲁胺（50 mg/d）作为二线内分泌治疗方案应用于中国雄激素非依赖性前列腺癌患者具有确切的疗效;治疗前是否有氟他胺撤除综合征及入组PSA水平可能是预测疗效和患者生存的独立影响因子。