前列腺癌的流行病学特征及晚期一线内分泌治疗分析

目的 分析北京、上海、广州的三个中心前列腺癌的流行病学特征,初步反映中国发达地区的前列腺癌现状.对晚期前列腺癌患者内分泌治疗相关资料进行分析,寻找内分泌治疗效果以及生存预后的预测因子.方法 收集三个中心525例前列腺癌患者的临资料,进行流行病学分析.并对其中272例资料完整的晚期前列腺癌患者的内分泌治疗效果以及生存预后进行分析.结果 68.0%的患者确诊时已属于晚期,80.2%的患者以内分泌治疗为主要治疗手段.Gleason分值、有无骨转移和血清前列腺特异性抗原最低点是晚期前列腺癌疾病进展的独立预后因子.结论 绝大多数患者在确诊时已经为疾病晚期,内分泌治疗是主要治疗方法.Gleason分值、有无骨转移和PSA最低点是晚期前列腺癌疾病进展的独立预后因子.     

去势抵抗前列腺癌治疗现状及研究进展

前列腺癌经传统的雄激素剥夺治疗后,常转归为去势抵抗性前列腺癌从而影响患者的生活质量。目前,关于CRPC的治疗是研究热点之一,虽然近年来去势抵抗前列腺癌的治疗取得了很大的进展,但是针对去势抵抗前列腺癌治疗目前缺乏行之有效的方法使患者获得满意的生存时间。本文就CRPC的治疗进行综述,为临床对患者行治疗提供参考。     

前列腺癌的化疗研究近况

化疗正成为治疗前列腺癌的有效手段。两项研究证实,以多西紫杉醇为基础的联合化疗对改善激素抵抗性前列腺癌患者的生存有益。多西紫杉醇联合泼尼松已经成为转移性激素抵抗性前列腺癌治疗的一线标准。化疗作为早期前列腺癌患者的新辅助治疗、辅助治疗及血清学复发治疗的多项研究正在进行中。     

尿液PCA3基因检测在前列腺癌诊治中的临床意义

目的 探讨前列腺按摩后尿液中PCA3基因表达在前列腺癌诊断和治疗中的临床应用.方法 收集前列腺增生患者34例,前列腺癌24例,取尿液,前列腺癌患者内分泌治疗后重新取尿液,分别离心后取沉淀物,用RT-PCR半定量方法检测PCA3表达情况.结果 前列腺增生患者尿液中未找到PCA3基因,前列腺癌患者尿液PCA3基因表达呈阳性,内分泌治疗前后前列腺癌患者尿液PCA3基因表达有显著差异.结论 尿液PCA3检测可以作为前列腺癌诊断的一个指标,可以对前列腺癌的治疗进行指导.它作为一种无创性诊断方法具有良好的前景.     

前列腺癌内分泌治疗患者药物素养的研究进展

准确、规范的内分泌药物治疗是控制前列腺癌疾病进展的有效手段。前列腺癌患者具有良好的药物素养,是延缓疾病进展的一个重要环节。本文综述了药物素养的概念、评价工具、影响因素和干预对策,旨在提高前列腺癌内分泌治疗患者的药物素养与认知水平,为前列腺癌患者规范、安全有效地进行药物治疗提供参考依据。     

原发灶减瘤根治性前列腺切除术治疗骨转移前列腺癌患者的现状及展望(附光盘)

前列腺癌具有很高的骨转移倾向。目前,国际和国内指南建议骨转移的前列腺癌患者选择全身系统性治疗,不推荐包括根治性前列腺切除术和前列腺放疗在内的局部治疗。近年依据美国SEER数据库和德国慕尼黑癌症登记的研究显示原发灶减瘤手术结合系统治疗可以使骨转移前列腺癌患者生存获益。本文就原发灶减瘤根治性前列腺切除术治疗骨转移前列腺癌患者的现状及展望进行综述。     

雌激素受体β在前列腺癌中的作用研究进展

前列腺癌是男性最常见的癌症之一,雄激素剥夺疗法(ADT)仍然是晚期前列腺癌患者的主要治疗方法,然而经过一段时间后这种方法最终会失败,患者会发展为去势抵抗性前列腺癌(CRPC),所以迫切需要新的治疗方法。越来越多的学者注意到雌激素及其受体在前列腺癌的作用,其中,雌激素受体β参与正常前列腺上皮细胞的分化及前列腺癌细胞的增殖作用,有望成为新的前列腺癌治疗靶点。本文对雌激素受体β在前列腺癌中的作用相关研究进行系统的综述。     

核素治疗前列腺癌骨转移疼痛疗效观察

目的:探讨前列腺癌骨转移疼痛的治疗方法,评价89SrCl2(二氯化89锶)治疗前列腺癌多发性骨转移的疗效,对12例前列腺癌骨转移疼痛患者,经静脉注射放射核素89Sr治疗后进行评价.结果:疼痛治疗的有效率为91.6％,但有患者出现轻度白细胞和血小板的降低现象,应予以重视.结论:放射性核素89 Sr治疗前列腺癌骨转移疼痛较为安全,有效,可以提高患者生活质量.     

前列腺癌根治性治疗后生化复发的评估和处理

目前,前列腺癌根治术或根治性放疗被认为是治疗临床局限犁前列腺癌的标准方法,前列腺癌生化复发特指发生在前列腺癌根治术后或放射治疗后.生化复发是肿瘤继续进展并发生临床复发或转移的前兆,随访中检出生化复发患者进行恰当的评估,可以筛选出高危患者接受进一步治疗,从而提高患者的生活质量.     

去势抵抗性前列腺癌的治疗新进展

随着人们生活方式的改变以及前列腺特异性抗原筛查的普及,前列腺癌的诊断和治疗更为重要。尽管内分泌治疗对于进展性前列腺癌有治疗效果,但最终会进展为去势抵抗性前列腺癌,从而严重影响患者的生存期。近年来,研究者对于去势抵抗性前列腺癌的治疗做出了巨大努力,包括新的内分泌治疗、细胞毒性的化学治疗、免疫治疗以及以骨转移为靶点的治疗方式逐步问世,本文就这些新的治疗进展进行综述,以期为临床医生及进展性前列腺癌患者提供更多的治疗选择,延长总体生存期,提高生活质量。     

Prostate cancer trends in the era of prostate-specific antigen. An update of incidence,mortality, and clinical factors from the SEER database

Concurrent with the successful life-saving efforts in terms of prostate cancer diagnosis and treatment, some men who do not need treatment are receiving it. These are men destined to die of causes other than prostate cancer. Unfortunately, at diagnosis, men needing treatment for prostate cancer cannot be differentiated from men who do not. To make such decisions correctly for individual patients would require extremely precise measures of the time to death from prostate cancer versus when the patient would die from a competing cause. Predictive tools with this level of accuracy will never be available given the inherent uncertainty of life. At the time of prostate cancer diagnosis, the date and the cause of death for the patient are matters of weak statistical speculation. Unless the date of death from prostate cancer and the date of death from non-prostate cancer causes can be precisely determined for each patient, some men will always be overtreated or undertreated. Conservative strategies result in the undertreatment of some patients who would benefit from treatment while sparing other patients unneeded treatment. Aggressive strategies result in the overtreatment of patients who do not need therapy while curing other men of prostate cancer. Both strategies are correct, but only some of the time. Better methods of determining the length of life and cause of death may improve this situation, but not by much. [figure: see text] Dramatic shifts in the incidence, grade, stage, and age of men with prostate cancer have been observed with the advent of widespread PSA-based cancer detection in the United States. Grade and stage trends suggest that more biologically relevant (the shift from well-differentiated to moderately differentiated tumors) and yet therapeutically amenable (earlier stage) tumors have been identified in large numbers of patients during the PSA era. Clearly many men have been diagnosed and treated who will not benefit from such treatment. The relative mix of these two groups of men is not known. Given the long delay between treatment and mortality that is inherent in prostate cancer (Fig. 14), the full effects of treatment on prostate cancer mortality are probably not yet seen in prostate cancer mortality data.     

Use of bone turnover marker, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), in the assessment and monitoring of bone metastasis in prostate cancer

BACKGROUND: We investigated whether a new marker of bone turnover, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), could be useful in the assessment of bone metastasis and in monitoring of the response to treatment in patients with prostate cancer with bone metastasis. METHODS: In all, 58 patients with prostate cancer (25 with bone metastasis and 33 without bone metastasis) and 52 patients with benign prostate hypertrophy who were treated between June 1994-August 1997 were included in this study. All patients were newly diagnosed. RESULTS: Serum ICTP levels in patients with prostate cancer with bone metastasis were significantly higher than those in patients with prostate cancer without bone metastasis (P<0.0001) or with benign prostate hypertrophy (P<0.0001). No significant differences were observed in serum ICTP levels between patients with prostate cancer without bone metastasis and those with benign prostate hypertrophy. Serum ICTP levels correlated significantly with Soloway's grading system for bone scans. Serum ICTP levels in patients with bone metastasis showed a significant downward trend in response to hormonal treatment. CONCLUSIONS: The determination of serum ICTP levels is useful in the assessment of bone metastasis and in monitoring the response of bone metastasis to treatment to prostate cancer.     

A randomized trial of choice of treatment in prostate cancer: the effect of intervention on the treatment chosen

OBJECTIVE: To determine whether different approaches in the choice of treatment affect the treatment chosen by the patient for prostate cancer. PATIENTS AND METHODS: We conducted a randomized trial with 210 men who had a histologically confirmed diagnosis of prostate cancer in 1993-94 at four major hospitals in Finland. After obtaining informed consent the men were randomized either to an intervention arm, in which there was greater patient participation in the choice of treatment following a structured procedure, or a control arm in which the standard approach, i.e. a standardized treatment protocol, was used. The main outcome measure of the analysis was the primary treatment chosen for prostate cancer. RESULTS: In the enhanced participation arm patients not eligible for radical prostatectomy chose orchidectomy less frequently and favoured nonsurgical endocrine treatment than in the treatment protocol arm. Radical prostatectomy was the most commonly chosen treatment option in both arms among men with operable cancer. The way treatment options were presented affected the treatment chosen for prostate cancer. CONCLUSION: Patients with prostate cancer are willing and able to take an active role in making decisions. The preferences of patients with prostate cancer in the choice of treatment may differ from the priorities of the physicians.     

Bladder cancer incidence and risk factors in men with prostate cancer: results from Cancer of the Prostate Strategic Urologic Research Endeavor

PURPOSE: We evaluated a large disease registry to determine the incidence of bladder cancer in patients with prostate cancer and investigate whether the type of treatment for prostate cancer increased the risk of bladder cancer. MATERIALS AND METHODS: We analyzed the CaPSURE disease registry for men diagnosed with prostate cancer plus bladder cancer between 1989 and 2003. Demographics, comorbidities and prostate cancer treatment modalities were compared in patients with and without bladder cancer. A backward stepwise Cox proportional hazards regression model was used to predict bladder cancer onset after treatment for prostate cancer in patients who had bladder cancer 30 days or greater after prostate cancer treatment. RESULTS: Of 9,780 patients from CaPSURE 143 (1.46%) also had bladder cancer. Patients with bladder cancer and prostate cancer were older (p<0.01) and more likely to be white (p=0.03), and they had lower levels of income (p<0.01) and education (p=0.04) than patients with prostate cancer only. Comorbidities did not differ between patients with and without bladder cancer. Patients treated with radical prostatectomy were approximately half as likely to have posttreatment bladder cancer as patients who underwent radiation therapy (HR 0.51, 95% CI 0.29-0.89). Patients who smoked had an independent increase in the risk of bladder cancer (HR 2.08, 95% CI 1.09-3.97), while smokers treated with radiation therapy were at almost 4-fold risk for bladder cancer (HR 3.65, 95% CI 1.45-9.16). CONCLUSIONS: The incidence of bladder cancer in patients with prostate cancer was 1.5%. Radiation therapy and smoking increased the risk of bladder cancer.     

Prostate cancer in the elderly

Prostate cancer is the most frequent malignancy in men and predominantly in elderly men. The issue of prostate cancer is likely to assume greater importance with progressive aging of the population. With frequent use of PSA testing most patients were diagnosed with localized cancer even in senior adults. Cancer-specific mortality is low in elderly men with prostate cancer and is dependent on the aggressiveness of the tumor. Currently, no established guidelines for the management of prostate cancer in the elderly exist, and treatment of senior adults with localized cancer is not optimal. While elderly men with indolent disease will not benefit from curative treatment, some patients with aggressive cancers will progress if not adequately treated. Comorbidity is the main predictor of life expectancy in the elderly. In everyday clinical practice, treatment decisions are much more influenced by age than by comorbidity. Curative treatment is an effective treatment option for selected elderly with localized prostate cancer. Conversely, most elderly men with prostate cancer received hormonal therapy, although the benefit of hormonal therapy in localized cancer is not clear and is associated with severe toxicities in some patients. In conclusion, there is a need for more risk stratified approaches for the management of prostate cancer in the elderly to avoid unnecessary intervention in men who unlikely benefit from such intervention, and allow treatment in those who might benefit from it.     

Trends in the curative treatment of localized prostate cancer after the introduction of prostate-specific antigen: data from the Rotterdam Cancer Registry

OBJECTIVE: To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing. PATIENTS AND METHODS: Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry. RESULTS: In the period 1989-95, 4344 patients were diagnosed with prostate cancer and the age-standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours. CONCLUSION: While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care.     

Peptide analogs in the therapy of prostate cancer

The use of peptide analogs in the therapy of prostate cancer is reviewed. The preferred primary treatment of advanced androgen-dependent prostate cancer is presently based on the use of depot preparations of LH-RH agonists. This treatment is likewise recommended in patients with rising PSA levels after surgery or radiotherapy. LH-RH agonists with or without antiandrogens can be also utilized prior to or following various local treatments in patients with clinically localized prostate cancer and at high risk for disease recurrence. LH-RH antagonists like Cetrorelix are in clinical trials. However, most patients with advanced prostatic carcinoma treated by any modality of androgen deprivation eventually relapse. Treatment of relapsed androgen-independent prostate cancer remains a major challenge, but new therapeutic modalities are being developed based on antagonists of growth hormone-releasing hormone (GH-RH) and bombesin, which inhibit growth factors or their receptors. Another approach consists of cytotoxic analogs of LH-RH, bombesin, and somatostatin containing doxorubicin or 2-pyrrolinodoxorubicin, which can be targeted to receptors for these peptides found in prostate cancers and their metastases. These cytotoxic analogs inhibit growth of experimental androgen-dependent or -independent prostate cancers and reduce the incidence of metastases. A rational therapy with peptide analogs could be selected on the basis of receptors present in biopsy samples. The approaches based on peptide analogs should result in a more effective treatment for prostate cancer.     

The Charlson comorbidity score: a superior comorbidity assessment tool for the prostate cancer multidisciplinary meeting

INTRODUCTION: Multidisciplinary team (MDT) meetings use precise prognostic factors to select treatment options for patients with prostate cancer. Comorbidity is judged subjectively. Recent publications favour the Charlson comorbidity score (CS) for the use in the management of prostate cancer. We assess the feasibility of using the CS by our MDT in planning the treatment of patients with prostate cancer. PATIENTS AND METHODS: Patients from the histopathology database aged less than 75 years and with a diagnosis of localized prostate cancer between 1993 and 1995 were included in a notes audit. A second group consisted of patients recommended for curative treatment for localized prostate cancer by the local MDT in 2004. Data on comorbidity, prostatic malignancy and survival up to 10 years was collected. The prognostic accuracy of the CS was assessed for those patients offered radical treatment between 1993 and 1995. RESULTS: Of 1043 patients initially assessed, 37 patients with localized prostate cancer were identified. Using Cox regression, we found the CS to be a statistically significant predictor of survival, following radical treatment for localized prostate cancer (P=0.005). Current practice in 2004 (56 patients) shows a mean (range) Charlson probability of 10-year survival for radical prostatectomy of 0.823 (0.592-0.923) and for radical radiotherapy of 0.653 (0.07-0.936). CONCLUSIONS: Our results support the findings of recent research. We also found the CS easy to calculate and therefore feasible to use in our MDT setting. We propose the introduction of the Charlson score by prostate cancer MDTs to assess age and comorbidity.     

Neoadjuvant hormone therapy and radical prostatectomy: the jury is still out

Radical prostatectomy may lead to cure as long as the cancer is confined to the prostate and all malignant cells are removed. However, clinical staging is inaccurate and a significant proportion of cT1-T2 patients have positive margins which increases the likelihood of disease progression within 5 years of surgery. Neoadjuvant hormone therapy is one option being used to increase the likelihood of prostate cancer cure after radical prostatectomy. Randomized clinical trials using neoadjuvant hormone therapy and radical prostatectomy have been conducted mainly in patients with cT1 and cT2 prostate cancer. A decrease in the number of positive surgical margins was found in cT1 and cT2 prostate cancer patients receiving neoadjuvant hormone therapy, with a further decrease in those receiving treatment over longer periods. In cT3 prostate cancer patients equivocal results have been obtained and further research is needed. None of the studies reported so far were able to define the impact of neoadjuvant treatment on the surgical management of locally advanced prostate cancer. Additional studies are required to determine the optimal type and duration of hormone treatment. Furthermore, long-term follow-up is needed to evaluate whether neoadjuvant therapy will improve overall survival. In the meantime, patients must be informed of the advantages and disadvantages of treatment to allow them to make informed treatment decisions.     

Outcome of radical prostatectomy for incidental carcinoma of the prostate

OBJECTIVE

To evaluate a contemporary series of patients with incidental prostate cancer detected by transurethral resection of the prostate (TURP) and undergoing radical prostatectomy (RP).

PATIENTS AND METHODS

Between 1998 and 2004, 1931 patients had TURP for obstructive voiding symptoms and suspected BPH. Incidental prostate cancer was found in 104 (5.4%); 26 of these patients had a RP. The pathological staging and treatment of these patients were reviewed retrospectively and the follow‐up results obtained.

RESULTS

Of the 26 patients who had RP, 17 had T1a and nine had T1b carcinoma of the prostate. After RP, six (35%) in the T1a group had no residual tumour (pT0) and 11 (65%) had pT2 cancer; the respective incidence in those with T1b was two and seven, with no pT3 disease in either group. The preoperative Gleason grading did not correspond well with that after RP; 30% of the patients had upgraded Gleason scores and 42% showed either downgrading or no residual tumour, with 81% having Gleason scores of <7. After a median follow‐up of 47 months, one patient is receiving hormonal therapy because of biochemical relapse.

Conclusion

Subsequent to stringent PSA testing and prostate biopsy when indicated, the rate of incidental prostate cancer is low. Furthermore, substantially many patients will harbour either no residual cancer or tumours with favourable characteristics in their RP specimens. However, there is currently no possibility to reliably predict the absence of aggressive prostate cancer after TURP, and thus safely recommend observation instead of further therapy. Therefore, patients with incidental prostate cancer need to be counselled individually. The decision ‘treatment or no treatment’ should be determined by the patients’ age and life‐expectancy, tumour aggressiveness in the TURP specimen and the prostate‐specific antigen level after TURP.