近距放疗联合间歇性内分泌治疗在前列腺癌治疗中的应用

目的:分析比较125I粒子植入近距放疗联合间歇性内分泌治疗在前列腺癌治疗中的效果。方法:回顾2001年1月～2011年2月期间未接受根治性前列腺切除而接受治疗满5年的147例前列腺癌患者,按治疗方式分为三组;A组43例单纯采用间歇性内分泌治疗;B组31例单纯采用近距离125I粒子植入;C组73例施行近距离125I粒子植入+间歇性内分泌治疗。比较三组患者的临床症状、PSA变化情况、局部进展率、无事件生存率。结果:147例患者,A组5年生存率为88.37%,无效率13.95%,无事件生存率16.28%;B组生存率为90.32%,无效率22.58%,无事件生存率32.26%;C组生存率为90.41%,无效率6.85%,无事件生存率34.25%。结论:近距离125I粒子植入+间歇性内分泌联合治疗作为前列腺癌的综合治疗手段,可以提高无事件生存率、增加治疗有效率、缩短内分泌治疗时间。     

中/低危前列腺癌近距离照射联合雄激素阻断治疗与根治术联合雄激素阻断的疗效比较

目的 对比近距离照射联合雄激素阻断与根治术联合雄激素阻断治疗对中/低危前列腺癌患者生存预后影响的差异。方法回顾性分析首都医科大学附属北京安贞医院2015年1月至2019年1月期间接受近距离照射联合雄激素阻断治疗(BT+ADT组,68例)或前列腺癌根治术联合雄激素阻断治疗(RP+ADT组,85例)的153例中/低危前列腺癌患者的临床资料,比较两组患者的生存预后及前列腺特异性抗原(PSA)动力学差异。结果 BT+ADT组与RP+ADT组PSA动力学资料差异无统计学意义(P0.05)。随访过程中死亡7例,其中RP+ADT组4例(4/85),BT+ADT组3例(3/68),两组患者无病生存率及总体生存率差异均无统计学意义(P0.05)。结论 中/低危前列腺癌患者中,根治术联合雄激素阻断与近距离照射联合雄激素阻断治疗治疗效果相当。     

I125放射性粒子植入联合低剂量调强适形放疗及内分泌治疗在中晚期前列腺癌中的临床疗效评价

目的 探讨I125放射性粒子植入(BT)联合低剂量调强适形放疗(IMRT)及间歇内分泌治疗(IHT)在中晚期前列腺癌中的临床疗效.方法 回顾性分析选择2009年9月～2014年3月采用BT联合IMRT及IHT治疗中晚期前列腺癌患者16例作为联合治疗组;选择同期单纯采用间歇内分泌治疗患者25例作为对照组.比较两种治疗方法对于治疗中晚期前列腺癌临床疗效的差异.结果 16例随访21 ～ 62个月,中位随访时间46个月.与对照组相比,联合组PSA、IPSS评分、尿流率及前列腺体积明显下降(P＜0.05),联合治疗5年累计生存率为48.3％,高于对照组的43.2％,差异有统计学意义(P＜0.05).结论 BT植入联合低剂量IMRT及IHT治疗中晚期前列腺癌,可有效提高患者生存率,是中晚期前列腺癌治疗可选择的有效手段之一.     

T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效观察及预后因素分析

目的 探讨T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效及预后影响因素.方法 2003年1月至2008年12月北京协和医院泌尿外科诊治T3a期前列腺癌患者38例,年龄48 ～ 84岁,平均71岁;前列腺特异性抗原(PSA) 10.000 ～99.800 μg/L,平均56.300 μg/L;Gleason评分5～9分,平均7.6分;穿刺活检针数阳性率10.0％～ 100％,平均65.3％.治疗方案为前列腺癌近距离治疗联合外放疗和内分泌治疗,观察患者联合治疗的效果,并运用Kaplan-Meier法绘制生存曲线.以患者术前年龄、前列腺体积、血清PSA值、Gleason评分和穿刺活检针数阳性率为变量,分别对生化复发、远处转移和总体生存状态行单因素分析.结果 38例患者随访9～ 109个月,平均69个月.19例出现生化复发,发生时间在术后1～ 40个月,平均13.4个月.13例出现远处转移,发生时间在术后1 ～ 70个月,平均19.7个月;15例死亡,9例死因为前列腺癌复发,6例为其他死因,平均死亡时间为术后52.2个月(9.0～98.5个月).总体的5年无生化复发率、无远处转移率、肿瘤特异生存率及总体生存率分别为44.1％、68.6％、82.4％及75.8％.29例患者出现1～2级泌尿系统不良反应,18例患者出现1～2级胃肠道不良反应.在单因素分析中,穿刺活检针数阳性率对生化复发(x2=17.240,P=0.000)、远处转移(x2=18.641,P=0.000)及总体生存状态(x2=8.970,P =0.003)有显著影响;Gleason评分对远处转移(x2=12.484,P=0.000)和总体生存状态(x2=6.575,P=0.010)有显著影响;年龄对总体生存状态(x2=5.179,P=0.023)有显著影响.结论 近距离治疗联合外放疗和内分泌治疗是T3a期前列腺癌的可选择方案,穿刺活检针数阳性率是影响患者生化复发、远处转移及总体生存率的因素.     

伽玛刀结合内分泌治疗中晚期前列腺癌疗效分析

目的 分析伽玛刀联合内分泌治疗对中晚期前列腺癌的治疗效果.方法 回顾性分析伽玛刀联合内分泌治疗中晚期前列腺癌21例的临床资料.内分泌治疗采用去势加抗雄激素治疗的联合雄激素阻断治疗,所有患者放射治疗前均接受双侧睾丸切除.放疗方案,3.8～5.0 Gy/次,隔日一次,治疗次数为10 ～13次,总放疗计量38.0～ 55.0Gy.结果 所有患者顺利完成放射治疗.17例患者治疗6个月后血清PSA降至正常.出院后随访平均24个月(6～60个月),3、5年生存率分别为76.2％( 16/21)和66.7％( 14/21).结论 伽玛刀联合内分泌治疗前列腺癌疗效满意,副反应小,是中晚期前列腺癌综合治疗的有效手段.     

三维适形放疗加内分泌联合治疗晚期前列腺癌

目的评价三维适形放疗加内分泌联合治疗晚期前列腺癌的效果。方法对晚期前列腺癌患者25例行3DCRT 内分泌联合治疗(联合组),以同期进行的单纯内分泌治疗的晚期前列腺癌患者40例为对照组。随访时间3~48个月,中位随访期27个月。结果联合组3年生存率为88.0%,明显高于对照组(68.0%)。在30个月后,联合组的PSA低于对照组,差异有统计学意义(P<0.05)。结论3DCRT 内分泌联合治疗晚期前列腺癌疗效满意,优于单纯内分泌治疗。     

前列腺癌治疗方法与生存预后的分析

目的　探讨早期前列腺癌的有效治疗方法及影响生存预后的重要因素。　方法　回顾分析 3 0年间收治的 3 17例前列腺癌患者的生存资料 ,并根据不同的临床分期、分级及治疗方法进行分类 ,计算患者总生存率与疾病特异生存率 ,并对影响患者存活的各种预后因素进行统计学分析。　结果　 3 17例前列腺癌患者 5、10和 15年总生存率分别为 73 .1%、51.8%和 3 5.3 % ,疾病特异生存率分别为 85.1%、72 .9%和 72 .9%。其中 3 6例采用根治性前列腺切除术、57例采用放射治疗患者的10年疾病特异生存率分别达到 10 0 .0 %和 78.0 % ,优于其它治疗方法。Cox模型多因素分析显示 :临床分期 (RR =2 .17,CI 1.43～ 3 .2 8,P =0 .0 0 0 0 )和分级 (RR =2 .54,CI 1.3 7～ 4.68,P =0 .0 0 0 3 )是影响患者存活的重要因素。　结论　根治性前列腺切除术与局部照射是早期前列腺癌患者的有效治疗方法 ,辅助内分泌治疗有益于提高疗效、促进存活。临床分期与分级是影响前列腺癌患者生存预后的重要因素     

中晚期前列腺癌临床治疗分析

目的 :探讨放疗、内分泌治疗和联合治疗对前列腺癌的临床疗效及PSA的临床诊断价值。　方法 :回顾总结 1986～ 1997年 5 0例C期以上前列腺癌临床治疗资料 ,比较不同治疗方法的客观生存率及PSA在治疗前后的变化。　结果 :治疗前 93 .7%病人PSA >4μg/L ,内分泌治疗后PSA水平下降 80 %～ 86 % ;80 %肿瘤发展病人PSA升高 1倍以上。手术去势组C期病人 2年和 5年生存率为 10 0 %和 6 6 % ;D期为 82 %和 36 %。放疗组C、D期 2年和 5年生存率分别为 10 0 %、5 0 %和 5 0 %、0。放疗联合去势术治疗C期病人 2年和 5年生存率为 10 0 %和 77%。药物治疗组 2年生存率为 90 %。　结论 :PSA是诊断前列腺癌及评价治疗预后的敏感指标。放疗联合内分泌治疗是C期前列腺癌的有效治疗方法 ,内分泌治疗D期前列腺癌优于放疗     

近距离照射在晚期前列腺癌治疗中的作用

目的：探讨近距离照射治疗在晚期前列腺癌中的效果及临床意义.方法：接受近距离照射治疗的晚期前列腺癌患者8例.年龄63～81岁,平均72岁.Gleason评分7～10分,平均8分;临床分期全部为D期.通过直肠超声定位引导进针,治疗剂量130～145Gy,植入粒子36～70粒.术前使用雄激素全阻断治疗6～18个月.结果：8例随访1～6年,平均4年.PSA均〈1μg/L,CT检查见前列腺明显缩小,ECT提示原骨转移灶变化不明显.术后3个月内均有不同程度的尿路刺激症状,术后8个月有2例有明显尿频、排尿困难,无放射性膀胱直肠炎、尿道狭窄和死亡病例.结论：近距离照射对于晚期前列腺癌提供了一较为可行的原发病灶治疗方法,同时可能通过放射源对原发病灶的控制,来抑制转移病灶的进展.近距离照射疗法应用于晚期的前列腺癌治疗,方法简单,效果满意.     

前列腺癌根治术后是否立即辅助内分泌治疗的META分析

目的 通过Meta分析对前列腺癌根治术后是否立即辅助内分泌治疗进行综合比较.方法 通过Pubmed、EMbase、Science Direct等数据库检索1990年至2013年相关文献.Jadad质量记分法评价纳入研究的质量,治疗组为前列腺癌术后立即给予内分泌治疗,对照组为前列腺癌术后延迟给予或不给予内分泌治疗,Meta分析评价两组总体生存率、肿瘤特异性生存率和无进展生存率.结果 5项研究入选,共4964例患者,分为治疗组2088例,对照组2876例.治疗组与对照组比较,总体生存率无统计学差异(P=0.71),肿瘤特异性生存率(P＜0.0001)和无进展生存率(P＜0.0001)有统计学差异.结论 前列腺癌根治术后立即辅助内分泌治疗可以显著提高病人的肿瘤特异性生存率和无进展生存率,但不能提高总体生存率.     

Oncological impact of neoadjuvant hormonal therapy on permanent iodine‐125 seed brachytherapy in patients with low‐ and intermediate‐risk prostate cancer

Objectives

To determine whether neoadjuvant hormonal therapy improves oncological outcomes of patients with localized prostate cancer treated with permanent brachytherapy.

Methods

Between January 2004 and November 2014, 564 patients underwent transperineal ultrasonography‐guided permanent iodine‐125 seed brachytherapy. We retrospectively analyzed low‐ or intermediate‐risk prostate cancer based on the National Comprehensive Cancer Network guidelines. The clinical variables were evaluated for influence on biochemical recurrence‐free survival, progression‐free survival, cancer‐specific survival and overall survival.

Results

A total of 484 patients with low‐risk (259 patients) or intermediate‐risk disease (225 patients) were evaluated. Of these, 188 received neoadjuvant hormonal therapy. With a median follow up of 71 months, the 5‐year actuarial biochemical recurrence‐free survival rates of patients who did and did not receive neoadjuvant hormonal therapy were 92.9% and 93.6%, respectively (P = 0.2843). When patients were stratified by risk group, neoadjuvant hormonal therapy did not improve biochemical recurrence‐free survival outcomes in low‐ (P = 0.8949) or intermediate‐risk (P = 0.1989) patients. The duration or type of hormonal therapy was not significant in predicting biochemical recurrence. In a multivariate analysis, Gleason score, pretreatment prostate‐specific antigen, clinical T stage, and prostate dosimetry, primary Gleason score and positive core rate were significant predictive factors of biochemical recurrence‐free survival, whereas neoadjuvant hormonal therapy was insignificant. Furthermore, neoadjuvant hormonal therapy did not significantly influence progression‐free survival, cancer‐specific survival or overall survival.

Conclusions

In patients with low‐ or intermediate‐risk disease treated with permanent prostate brachytherapy, neoadjuvant hormonal therapy does not improve oncological outcomes. Its use should be restricted to patients who require prostate volume reduction.     

寡转移CRPC原发灶与转移灶全覆盖放疗的疗效和毒性反应分析

目的:探讨原发灶和所有转移灶同时全覆盖放疗治疗寡转移性去势抵抗性前列腺癌(CRPC)的疗效和毒性反应。方法:回顾性分析北京大学第一医院2011年10月至2017年6月收治的44例寡转移(≤4处转移灶)CRPC患者的临床资料。平均年龄72(57~86)岁,初诊时PSA中位值38.545(6.640~1 066.000)n...     

Prostate brachytherapy: treatment strategies.

PURPOSE: Patients who present with localized and locally advanced prostate cancer may be candidates for prostate brachytherapy. We evaluated the treatment outcomes in a diverse group of prostate cancer patients who presented with low, moderate and high risk features. MATERIALS AND METHODS: A total of 301 patients who presented with T1 to T3 prostate cancer were treated with brachytherapy alone or combined with hormonal therapy and/or external beam irradiation. Of these patients 109 at low risk with prostate specific antigen (PSA) 10 ng./ml. or less, Gleason score 6 or less and clinical stage T2a or less were treated with 125iodine alone, 152 at moderate risk with PSA greater than 10 ng./ml., Gleason score greater than 6 or stage T2b or greater were treated with 125iodine or 103palladium or combined implant alone with 5 months of hormonal therapy, and 40 at high risk with PSA greater than 15 ng./ml., Gleason 8 or greater, clinical stage T2c to T3 or positive seminal vesicle biopsy (20) were treated with combination brachytherapy, external beam irradiation and 9 months of hormonal therapy. Patients with a positive seminal vesicle biopsy (T3c disease) and negative pelvic lymph nodes were included in the high risk group, and the walls of the seminal vesicles were also treated with implantation. Followup was performed every 6 months with digital rectal examination and ultrasound evaluation. Prostate biopsy was routinely recommended 2 years after completion of the radiation. Failure was defined as PSA increase on 2 consecutive determinations above 1 ng./ml. or evidence of local recurrence on digital rectal examination, transrectal ultrasound or biopsy. Kaplan-Meier projections were used to calculate progression-free survival rates. RESULTS: Of the 109 patients at low risk followed from 1 to 7 years (median 18 months) 91% were free of PSA failure at 4 years. No patient experienced urinary incontinence following implantation, although grade 1 to 2 radiation proctitis occurred in 5 (4.5%). Of the 152 patients at moderate risk 73 received implantation and 79 received implantation combined with hormonal therapy. The 4-year biochemical freedom from failure rate for the hormone group was 85% versus 58% for the no hormone group (p = 0.08). The difference was more significant for those with Gleason score 7 or greater (90 versus 43%, p = 0.01) and for those with PSA greater than 10 ng./ml. (87 versus 59%, p = 0.04). Grade 1 to 2 radiation proctitis occurred in 1 of the 79 patients (1.3%) receiving hormonal therapy and in 3 (4%) treated with implantation only. There were no cases of urinary incontinence. Of the 40 patients at high risk 71% were free of biochemical failure at 3 years. Of the 4 patients with failure (10%) 3 (75%) originally had positive seminal vesicle biopsies. Five patients experienced gastrointestinal complications, although none was grade 3 or 4. The actuarial freedom from grade 2 proctitis was 82%. No patient experienced urinary incontinence. Prostate biopsies were negative in 87% of the low risk, 96.8 (hormone group) versus 68.6% (no hormone group) of the moderate risk (p = 0.0023) and 86% of the high risk patients. CONCLUSIONS: Brachytherapy appears to offer comparable results to external beam irradiation and radical prostatectomy when patients are stratified by disease extent. Adopting a strategy of implant alone, implant with hormonal therapy or implant with hormonal therapy and external beam irradiation in patients who present with low to high risk features can improve the overall results in the more advanced cases.     

Emerging novel therapies in the treatment of castrate-resistant prostate cancer

The treatment options for patients with castration-resistant prostate cancer (CRPC), until very recently, only included docetaxel. In the past 10 months, newly Federal Drug Administration (FDA) approved agents in the United States have shown survival benefit for patients with CRPC. This review takes a closer look at these newer agents: sipuleucel-T (immune therapy) and cabazi-taxel (cytotoxic therapy). We also review the evidence supporting the FDA’s approval of denosumab (bone-targeted therapy) as a treatment option for men with CRPC and bony metastases. Newer agents currently being investigated in phase III clinical trials for their potential role in metastatic CRPC are also reviewed. These agents include abiraterone (hormonal therapy), TAK-700 (hormonal therapy), MDV3100 (hormonal therapy), ipilimumab (immune therapy), zibotentan (endothelin-A receptor antagonist) and dasatinib (tyrosine kinase inhibitor). As ongoing studies using all the aforementioned agents continue to evolve, our understanding of how and where these agents fit into the treatment paradigm for patients with CRPC will become clearer.     

High-dose rate iridium-192 brachytherapy combined with external beam radiotherapy for localized prostate cancer

PURPOSE: We report our technique and also preliminary results in the cases with localized prostate cancer treated by the combination of high-dose rate Iridium-192 (HDR-Ir192) brachytherapy and external irradiation. MATERIALS AND METHODS: From June 1999 to August 2000, 17 patients were treated by the combination of HDR-Ir 192 and external beam. The mean age of patients was 72 years (range, 48-81 years). The clinical stage was B1 in 5, B2 in 7 and C (no cancer with seminal vesicle) in 5 cases. Of 10 patients without neoadjuvant hormonal therapy, the median initial pretreatment PSA was 15.3 ng/ml (6.93-222.32 ng/ml). The treatment was given by HDR-Ir 192 brachytherapy (6 Gy x 3 times/2 days) and external beam irradiation (40 or 45 Gy). The brachytherapy was given using TRUS guided percutaneously inserted temporary needles with a high dose rate remote afterloading control. Local control was evaluated by digital rectal examination. TRUS-guided biopsies and serum PSA evaluations. Follow-up ranged from 2 to 14 months, with a median of 8 months. RESULTS: In 4 (40.0%) of 10 patients without neoadjuvant hormonal therapy the level of serum PSA was decreased to less than 4.0 ng/ml within 3 months after the therapy. The effective grade in the biopsy specimens of 8 patients without neoadjuvant hormonal therapy was Grade Ob in 4, Grade 1 in 1, Grade 3 in 3 cases at 3 months after the therapy. No severe intra- or peri-operative complications occurred. CONCLUSION: The combined radiotherapy treatment is safe and effective for use in the patients with localized prostate cancer. However, more comprehensive studies involving long-term follow-up and great numbers of the cases with localized prostate cancer treated by the combination of HDR-Ir 192 brachytherapy and external irradiation will be necessary to determine whether this therapy contributes to better prognosis.     

Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Adjuvant hormonal therapy is known to improve cancer specific survival in prostate cancer patients with lymph node positive disease. This study suggests that surgically treated prostate cancer patients with seminal vesical invasion (pT3b) may have improved cancer specific survival if treated with adjuvant androgen deprivation therapy, similar to lymph node positive patients.

OBJECTIVE

To determine the impact of adjuvant androgen deprivation therapy (ADT) on survival in patients with seminal vesicle invasion (pT3b) at radical prostatectomy.

PATIENTS AND METHODS

We reviewed 12 115 patients who underwent radical prostatectomy between 1987 and 2002 to identify patients with pT3bN0 prostate cancer who received adjuvant ADT (n= 191). These patients were matched by clinical and pathological variables to a group of patients with pT3b prostate cancer who did not receive adjuvant ADT. Median postoperative follow‐up was 10 years. Clinical endpoints included biochemical progression‐free survival (BPFS), local recurrence‐free survival (LRFS), systemic progression‐free survival (SPFS), cancer‐specific survival (CSS) and overall survival.

RESULTS

Patients who underwent adjuvant ADT experienced improved 10‐year BPFS (60% vs 16%, P < 0.001), LRFS (87% vs 76%, P= 0.002), SPFS (91% vs 78%, P= 0.004) and CSS (94% vs 87%, P= 0.037). Overall survival was not significantly different between groups (75% vs 69%, P= 0.12). Both luteinizing hormone‐releasing hormone agonists (hazard ratio, 0.26; 95% CI, 0.15–0.46; P < 0.001) and bilateral orchiectomy (hazard ratio, 0.13; 95% CI, 0.06–0.31; P < 0.001) improved BPFS. When stratified by type of ADT (hormonal therapy vs orchiectomy), there was no difference in survival outcomes.

CONCLUSIONS

Adjuvant ADT improves local, and systemic control after radical prostatectomy for pT3b prostate cancer. There is no difference in survival between patients receiving medical hormonal therapy vs patients undergoing orchiectomy. Given the lack of improvement in overall survival, continued investigation is needed to identify the cohort of pT3b patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach.     

三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的临床应用

目的：探讨三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的临床疗效。方法：将我院2003年1月-2008年12月收治60例晚期前列腺癌随机分为联合治疗组（放疗+激素阻断）、单一组（激素阻断）两组,每组30例。联合组放疗采用三维适形放疗（总剂量70-72 Gy,4-7周完成）;激素阻断治疗、单一激素阻断治疗组皆采用康士德+诺雷德方案（康士德50mg/日,顿服,诺雷德3.75 mg,皮下注射,1次/月,平均治疗周期12个月）。分别记录两组治疗后近期疗效（IPSS表评估下尿路症状缓解情况、VAS评分表评估疼痛情况、MRI复查评估肿瘤体积变化、血清PSA变化）、不良反应（胃肠道反应、肝肾功受损情况）、随访后评估患者生存率。结果：联合治疗组相比单一治疗组,IPSS评分下降更明显,疼痛减轻更显著,前列腺肿瘤体积下降更明显,血清PSA变化下降更明显,差异比较均有统计学意义（P<0.05）;不良反应相对较大,但差异比较无统计学意义（P>0.05）;随访后患者生存率更高,差异比较有统计学意义（P<0.05）。结论：三维适形放疗联合激素阻断治疗方案最大限度的解除了患者病痛和提高了患者的生存率,可以为晚期前列腺癌尤其是非雄激素依赖型前列腺癌的临床诊治提供新的治疗方法。     

前列腺癌间歇与持续性内分泌治疗疗效比较的Meta分析

目的通过Meta分析对间歇性内分泌治疗(IHT)与持续性内分泌疗法(CHT)治疗前列腺癌的疗效进行综合分析。方法通过Pubmed、EMbase、Science Direct、万方、中国知网等数据库检索自1990至2018年相关文献,并手工检索国内外相关杂志。Jadad质量记分法评估纳入研究的质量。治疗组(IHT组)患者使用间歇性内分泌疗法,对照组(CHT组)患者使用持续性内分泌疗法。Meta分析评价两组总体生存率、肿瘤进展期、肿瘤特异性生存率、无进展生存率、去势抵抗时间、生活质量、不良反应发生率。结果本研究纳入16篇文献,共计8400例病例。治疗组与对照组治疗前列腺癌(PCa)风险比比较,总体生存率(HR=1.02,P=0.62)、肿瘤进展期(HR=0.93,P=0.11)、肿瘤特异性生存率(HR=0.99,P=0.93)、无进展生存率(HR=1.01,P=0.41),比较差异无统计学意义。在患者去势抵抗时间方面,IHT组比CHT组更具优势(HR=0.80,P=0.02)。IHT组生活质量评分较CHT组明显升高(P<0.05),IHT组的一些不良反应发生率也较CHT组显著降低(P<0.05),如面部潮热、男性乳房胀痛增生、头痛,生活质量评分明显升高(P<0.05)。结论使用IHT和CHT治疗PCa的生存率差异无统计学意义,但IHT能够提高生存质量,降低患者不良反应的发生率,延缓进展至非激素依赖性前列腺癌的时间,降低用药剂量及治疗费用,值得临床推广。     

Increased risk of disease progression in younger men: Analysis of factors predicting biochemical failure and castration-resistant prostate cancer after high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer

BackgroundThe aim of this study was to investigate the clinical significance of the effect of age on disease control in men who received high-dose intensity-modulated radiation therapy (IMRT) for nonmetastatic prostate cancer (NMPCa).MethodsNMPCa patients with favorable intermediate to very high-risk features (National Comprehensive Cancer Network risk classification) treated with IMRT at our institution between September 2000 and May 2011 were analyzed retrospectively. Treatment consisted of high-dose IMRT (74–78 Gy/37–39 fractions) combined with 6 months of neoadjuvant hormonal therapy. Multivariable analysis using Fine and Gray's regression model was performed to evaluate whether age at initiation of IMRT was associated with biochemical failure (BF) and castration-resistant prostate cancer (CRPC) progression.ResultsA total of 367 patients were analyzed. The median follow-up period was 8.8 years after IMRT. The 5- and 10-year BF rates were 22.1 and 31.7%, and those of CRPC rates were 4.5 and 12.6%, respectively. Multivariable analysis revealed that a younger age (cut-off: 70 years old) at the initiation of IMRT was significantly correlated with both a higher BF rate (hazard ratio: 1.691, P= 0.0064) and higher CRPC rate (hazard ratio: 2.579, P = 0.0079).ConclusionsYounger men with NMPCa had increased risks of BF and CRPC after high-dose IMRT, and may benefit from more intensive treatments. Our findings should be further tested in prospective studies.     

Prostate-specific antigen response to deferred combined androgen blockade therapy using bicalutamide predicts survival after subsequent oestrogen and docetaxel therapies in patients with castration-resistant prostate cancer

Study Type – Prognosis (retrospective cohort analysis) Level of Evidence 2b What's known on the subject? and What does the study add? The additional use of anti‐androgen (deferred combined androgen blockade [CAB] therapy) for patients with castration‐resistant prostate cancer (CRPC) initially treated with androgen deprivation monotherapy (ADMT) can provide a clinical response, although the reported response rates vary widely. Our previous study, which reported a response rate of 66% to deferred CAB therapy, suggested that deferred CAB responders would also respond better to subsequent therapies than non‐responders because the difference in cancer‐specific survival between the deferred CAB responders and the non‐responders was much larger than the progression‐free survival rates for the responders. The present study showed that PSA response to deferred CAB therapy predicts clinical outcomes after subsequent oestrogen and docetaxel therapy. We propose that PSA response to deferred CAB be used for planning individualized treatment that includes secondary hormonal therapy and chemotherapy.

OBJECTIVE

• ? To evaluate whether there is any association between prostate‐specific antigen (PSA) response to deferred combined androgen blockade (CAB) therapy using bicalutamide in patients with castration‐resistant prostate cancer (CRPC), initially treated with castration monotherapy, and the clinical outcomes after subsequent oestrogen and docetaxel therapies.

PATIENTS AND METHODS

• ? Fifty‐six patients with advanced prostate cancer, who were refractory to both initial castration monotherapy and subsequent deferred CAB, received oestrogen therapy (estramustine phosphate 140 or 280 mg/day in 50 patients, diethylstilbestrol diphosphate 100 mg/day orally in six patients). Of the 56 patients, 33 underwent docetaxel therapy (median dose 55 mg/m², every 4–8 weeks, median 6 courses) when they became refractory to oestrogen therapy.
• ? A deferred CAB response was defined as a decrease of >50% in PSA levels after the addition of bicalutamide. The difference in cancer‐specific survival (CSS) after confirmation of resistance to initial castration monotherapy between the deferred CAB responders and the non‐responders was evaluated, and outcomes after oestrogen and docetaxel therapies were also compared between the two groups.

RESULTS

• ? A response to deferred CAB was observed in 27 (48%) of the 56 patients. There was no significant difference between the responders and the non‐responders in pretreatment clinical variables, including Gleason score, metastatic sites, PSA level at diagnosis, and PSA nadir during castration monotherapy.
• ? A deferred CAB response was a significant predictor of CSS after confirmation of resistance to initial castration monotherapy.
• ? The deferred CAB responders had significantly longer progression‐free survival (PFS) (median 3.2 months in the responders, 2.1 month in the non‐responders, P= 0.04) and CSS (median 3.0 years in the responders, 1.5 years in the non‐responders, P= 0.04) after oestrogen therapy. Likewise, PFS (median 8.2 months in the responders, 2.2 months in the non‐responders, P < 0.01) and CSS (median not reached in the responders, 1.4 years in the non‐responders, P < 0.01) after docetaxel therapy was significantly longer in the deferred CAB responders.

CONCLUSION

• ? PSA response to deferred CAB predicts clinical outcomes after subsequent oestrogen and docetaxel therapies in patients with CRPC, and provides useful information for planning individualized optimum treatment courses that include secondary hormonal therapy and chemotherapy.