经直肠高强度聚焦超声联合内分泌疗法治疗前列腺癌

目的探讨经直肠高强度聚焦超声联合内分泌疗法与单纯内分泌疗法治疗前列腺癌的疗效。方法将40例前列腺癌患者分为A、B两组，其中A组采用HIFU联合内分泌治疗，B组采用单纯内分泌治疗。HIFU治疗采用Sonablate 500型经直肠HIFU治疗系统，内分泌治疗采用去势加用抗雄激素药物治疗。随访时间8—24个月，平均16个月。结果A、B两组患者在治疗后，均出现了前列腺体积缩小，血清PSA均有不同程度下降，IPSS评分降低，Qmax明显提高，治疗前后差异有统计学意义（P〈0．05）。其中A组较B组改变更为明显，两者之间差异有统计学意义（P〈0．05）。结论高强度聚焦超声联合内分泌疗法及单纯内分泌疗法对前列腺癌的近期疗效均较好，前者疗效更为明显。     

TUVP联合TURP治疗合并膀胱出口梗阻的前列腺癌

目的:探讨治疗合并膀胱出口梗阻前列腺癌的有效方法。方法:联合应用经尿道前列腺电汽化术(TU-VP)与经尿道前列腺电切术(TURP)治疗合并膀胱出口梗阻的前列腺癌患者47例,结合去势术及术后雄激素阻断治疗。结果:47例患者住院时间6~14d,平均9.5d;术后随访6~52个月。国际前列腺症状评分(IPSS)由术前的(26.5±4.8)分下降到(8.5±2.2)分(P<0.05);最大尿流率(Qmax)从术前的(4.6±1.5)ml/s上升到(14.5±3.6)ml/s(P<0.05);前列腺特异性抗原(PSA)从术前的(58.1±7.2)μg/L下降到术后3个月的(3.6±1.8)μg/L(P<0.01)。结论:联合应用TUVP与TURP,配合去势术及术后雄激素阻断是治疗合并膀胱出口梗阻前列腺癌的有效方法。     

去势治疗对前列腺癌患者骨密度的影响

目的 :探讨去势治疗对前列腺癌患者骨密度 (BMD)的影响。　方法 :4 9例完成BMD测定的前列腺癌患者分为 2组 :非去势组 2 1例 ,在去势治疗前即已完成BMD测定 ;去势组 2 8例 ,均为去势治疗 1年以上者。BMD测定采用双能X线吸收法 (DEXA法 ) ,测定部位为腰椎 (L2～ 4)和股骨颈。为校正年龄、性别和体重因素对BMD的影响 ,与年龄、种族等相配对的Z评分被用于结果评估。　结果 :13例 (6 2 % )非去势组患者和 2 3例 (82 % )去势组患者均存在不同程度的BMD水平下降。在非去势组 ,腰椎 (L2～ 4)Z评分为 - (0 .9± 0 .7)分 ,股骨颈Z评分为 - (0 .6± 0 .5 )分 ;而在去势组 ,腰椎 (L2～ 4)Z评分为 - (1.8± 1.1)分 ,股骨颈Z评分为 - (1.6± 1.0 )分。与非去势组相比 ,去势组患者BMD水平明显偏低 ,差异有显著性 (P <0 .0 1)。　结论 :去势治疗前 ,前列腺癌患者常伴有不同程度的骨量减少和骨质疏松 ,去势治疗与前列腺癌患者BMD水平下降明显相关。在对前列腺癌患者采用去势治疗之前 ,BMD测定是必要的。     

高能聚焦超声治疗激素非依赖性前列腺癌

目的探讨高能聚焦超声（HIFU）治疗激素非依赖性前列腺癌的临床效果。方法对本组12例激素非依赖性前列腺癌行HIFU治疗，术后随访3—20个月，平均14个月。结果治疗前后血清前列腺特异性抗原（PSA）值分别为（42．5±20．2）ng／mL、（10．4±6．6）ng／mL；前列腺体积为（45．2±12．5）mL、（3．5±1．1）mL；国际前列腺症状评分为19．5±5．5、8．5±4．5，治疗前后比较具有显著差异（P〈0．05）；治疗并发症：轻度血尿2例。结论HIFU治疗激素非依赖性前列腺癌近期疗效确切、并发症少。     

前列腺癌组织中TGF-β1 mRNA表达及其临床意义

目的:探讨转化生长因子β1(TGF-β1)在前列腺癌中的表达及意义。方法:采用逆转录-聚合酶链反应(RT-PCR)法对前列腺癌组织中TGF-β1mRNA表达进行研究。结果:TGF-β1mRNA的相对含量值:在正常前列腺组织为0.74±0.11;在前列腺癌T1~T2期为(0.69±0.10),T3~T4期为(0.44±0.08);Gleason评分≤5分者为(0.70±0.12),6~8分者为(0.54±0.11),≥9分者为(0.42±0.09)。T1~T2期与正常前列腺相比,差异无显著性(P>0.05),T3~T4期与正常前列腺组织相比,差异有极显著性(P<0.01),T3~T4期与T1~T2期前列腺癌相比,差异有显著性(P<0.05)。Gleason评分≤5分者与正常前列腺相比,差异无显著性(P>0.05),6~8分者与正常前列腺相比,差异有显著性(P<0.05),≥9分者与正常前列腺相比,差异有显著性(P<0.01),≥9分者与≤5分及6~8分者相比,差异均有显著性(P<0.01和P<0.05)。结论:TGF-β1的mRNA表达与临床分期、病理分级呈负相关。     

PSAD与PSAD-TZ在前列腺良、性疾病诊断中的应用价值

目的 :比较前列腺特异性抗原密度 (PSAD)、前列腺移行带抗原密度 (PSAD TZ)、前列腺特异性抗原 (PSA)及游离前列腺特异性抗原和总前列腺特异性抗原比值 (FPSA/TPSA)在良性前列腺增生 (BPH)和前列腺癌 (PCa)鉴别诊断中的作用。　方法 :4 3例BPH和 2 0例PCa病人 ,PSA均 <2 0 μg/L ,比较PSA、PSAD、FPSA/TPSA、PSAD TZ指标 ,并进行统计学分析。　结果 :BPH和PCa两组PSA平均值分别为 (10 .4 7± 6 .2 5 )、(13.92± 3.2 0 ) μg/L ,差异无显著性 (P >0 .0 5 )。两组PSAD平均值分别为 (0 .15± 0 .12 )和 (0 .2 4± 0 .13) ,差异有显著性 (P <0 .0 5 )。两组FPSA/TPSA平均值分别为 (0 .5 8± 0 .4 2 )和 (0 .2 6± 0 .17) ,差异有显著性 (P <0 .0 5 )。两组PSAD TZ平均值分别为 (0 .2 6± 0 .2 2 )和 (0 .5 1± 0 .2 8) ,差异具有非常显著性。 (P <0 .0 1)。　结论 :PSAD、FPSA/TPSA、PSAD TZ对PSA <2 0 μg/L的前列腺良恶性增生病人具有鉴别作用 ,其中尤以PSAD TZ更为准确     

网状支架治疗前列腺增生的远期疗效观察

目的 :观察网状支架治疗良性前列腺增生 (BPH)的临床效果。方法 :对 36例BPH患者放置网状支架进行治疗 ,并分别于治疗后 6、12、2 4、4 8～ 6 0个月进行随访。结果 :全部患者术后均恢复排尿 ,早期有膀胱刺激征和血尿。获 2年以上随访的 17例患者 ,国际前列腺症状评分 (IPSS)从术前 2 8.6± 6 .2分减小至 6 .3± 3.9分 (P<0 .0 0 1) ,平均尿流率 (AFR)从术前 6 .8± 3.2ml s增加至 13.6± 6 .2ml s(P <0 .0 0 1) ,剩余尿量 (RUV)从术前15 6± 2 3.4ml减小至 4 2 .6± 30 .2ml(P <0 .0 0 1)。随访 4 8～ 6 0个月的 8例患者发生尿潴留 ,其中 3例作开放手术切除前列腺 ,1例拔除支架管后行前列腺电切术 ,另 4例行膀胱穿刺造瘘。结论 :网状支架是高危BPH患者的一种安全有效的近期治疗方法 ;放置支架管时间过长 ,可再次出现尿潴留 ,应根据患者情况作出适当处理     

125Ⅰ放射性籽源植入术联合内分泌疗法治疗前列腺癌的疗效评价（附29例报告）

目的：初步评价125Ⅰ放射性籽源植入术联合内分泌疗法治疗前列腺癌的临床疗效.方法：应用术中经直肠超声引导及治疗计划系统软件经会阴穿刺植入125 Ⅰ放射性籽源并同期行手术去势或药物去势治疗前列腺癌患者29例.结果：术后6个月～5年随访,发现29例患者前列腺体积及前列腺特异抗原（PSA）均有不同程度降低,8例淋巴结转移患者及4例骨转移患者转移灶均缩小,术前骨痛及排尿症状均有好转,且无一例出现尿潴留及便血等严重并发症.结论：125Ⅰ放射性籽源植入术并内分泌疗法对各期前列腺癌均有明显的治疗作用,是一种安全有效的前列腺癌综合治疗手段.     

经尿道前列腺切除治疗晚期前列腺癌下尿路梗阻

目的 :观察经尿道前列腺电切除术 (TURP)在治疗晚期前列腺癌相关的下尿路梗阻中的意义。　方法 :回顾性分析 2 0 0 2年 5月～ 2 0 0 3年 11月在我院接受TURP的 2 6例前列腺癌患者病史资料。　结果 :2 6例患者 ,年龄 5 6～92岁 ,中位年龄 75岁。C期 3例 ,D期 2 3例。 9例患者有尿潴留病史 ,其中 1例肾功能不全 ,膀胱造瘘 1个月后行TURP。 2 6例患者术中出血量不多 ,无 1例术中输血。术后 3～ 5d拔除导尿管后均可自行排尿 ,但并发暂时性尿失禁3例 ,经提肛肌练习后恢复正常。 9例曾有尿潴留病史的患者无 1例再次发生尿潴留 ,术后 8周国际前列腺症状评分(IPSS)和一般状况评分 (Karnofsky)均明显改善 [分别为 (2 9.7± 4 .6 )vs (8.6± 3.4 )、(5 5± 2 0 )vs (77± 32 )分 ,P均 <0 .0 5 ]。　结论 :TURP治疗前列腺癌相关的下尿路梗阻安全有效。     

特异性抗原密度联合前列腺穿刺活检诊断前列腺癌的价值

目的 :评价前列腺移行带特异性抗原密度 (PSAT)与前列腺穿刺活检联合检测在前列腺癌 (PCa)诊断中的价值。方法 :对 4 9例血清PSA >10 μg/L患者行前列腺穿刺活检后 ,部分给予重复穿刺及手术治疗 ,综合比较PSAT。结果 :4 9例中 ,前列腺活检病理检查诊断为PCa 2 4例 (4 8.98% ) ,良性前列腺增生 (BPH) 2 5例 (5 1.0 2 % ) ,其PSAT平均值分别为 (0 .6 1± 0 .11)、(0 .38± 0 .13) μg/L ,两者相比差别有统计学意义 (P <0 .0 1) ;后者行手术治疗后病理检查诊断为PCa 6例 (2 4 % ) ,BPH 19例 (76 % ) ,其PSAT平均值分别为 (0 .4 0± 0 .11)、(0 .32± 0 .0 7) μg/L ,两者相比差别有统计学意义 (P <0 .0 5 )。结论 :PSAT对PCa ,特别是早中期PCa的诊断 ,比前列腺穿刺活检更为敏感 ,二者联合检测对临床诊治有重要的价值和意义。     

Control of prostate cancer by transrectal HIFU in 227 patients

PURPOSE: To evaluate the results of high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer with reference to disease-related prognostic factors. MATERIALS AND METHODS: Patients with T1-2 localized prostate cancers, prostate specific antigen (PSA) 1 ng/ml with three consecutive rises. RESULTS: The study included 227 patients. Mean follow-up was 27+/-20 months (12-121 months). Eighty-six percent had negative control biopsies. Median nadir PSA was 0.10 ng/ml. The actuarial 5-year disease-free survival rate (DFSR), combining pathologic and biochemical outcomes, was 66%. DFSR showed a significant decrease when stratified according to initial PSA level: 90% with PSA 相似文献   

PSA nadir is a significant predictor of treatment failure after high-intensity focussed ultrasound (HIFU) treatment of localised prostate cancer

OBJECTIVES: To assess if prostate-specific antigen (PSA) nadir is an independent predictor of treatment failure and disease-free survival after high-intensity focussed ultrasound (HIFU) therapy for localised prostate cancer as defined by the new ASTRO criteria. METHODS: One hundred three patients after HIFU treatment (Ablatherm, EDAP, Lyon, France) for localised prostate cancer without previous hormonal therapy were evaluated retrospectively. Patients attended regular follow-up visits every 3 mo. Treatment failure was defined by the revised ASTRO criteria (PSA >or=2 ng/ml above nadir PSA, positive biopsy, if salvage treatment was administered). Patients were divided into three PSA nadir subgroups (group 1, 1 ng/ml). The disease-free survival rate (DFSR) was calculated by using life table methods. The log-rank test was used to compare the curves based on Kaplan-Meier models. RESULTS: The median follow-up was 4.9 (3-8.6) yr. Mean time to PSA nadir was 6.4+/-5.1 mo. A PSA nadir of 1ng/ml was reached by 64%, 22.3%, and 13.6% of patients, respectively. Treatment failure rates during follow-up were 4.5%, 30.4%, and 100%, respectively, for the three groups (p<0.001). The actuarial DFSRs at 5 yr were 95%, 55%, and 0%, respectively, for the 3 groups (p<0.001). CONCLUSIONS: The PSA nadir after HIFU correlates highly significantly with treatment failure and DFSR, and can be applied in daily clinical practice. Promising oncological outcome is obtained if a PSA nadir of 相似文献   

Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer

BACKGROUND AND PURPOSE: Criteria for determining the durability of the response to transrectal high-intensity focused ultrasound (HIFU) ablation of prostate cancer have been established by calculating progression-free probability. PATIENTS AND METHODS: A series of 82 patients (mean age 71 +/- 5.7 years) with biopsy-proven localized (stage T1-T2) cancer who were not suitable candidates for radical surgery underwent transfectal HIFU ablation with the Ablatherm machine. The mean follow-up was 17.6 months (range 3-68 months). The mean serum prostate specific antigen (PSA) value and mean prostate volume were 8.11 +/- 4.64 ng/mL and 34.9 +/- 17.4 cm3, respectively. Progression was rigidly defined as any positive biopsy result, regardless of PSA concentration, or three successive PSA increases for patients with a negative biopsy (PSA velocity > or = 0.75). Times to specific events (positive biopsy and PSA elevation) were analyzed with the Kaplan-Meier survival method. RESULTS: Overall, 62% of the patients exhibited no evidence of disease progression 60 months after transrectal HIFU ablation. In particular, the disease-free rate was 68% for the moderate-risk group of 50 patients (PSA < 15.0 ng/mL, Gleason sum < 8, prostate volume < 40 cm3, and number of positive biopsies < 5). For the low-risk group of 32 patients (PSA < 10 ng/mL and Gleason sum < 7), the disease-free survival rate was 83%. CONCLUSION: Transrectal HIFU prostate ablation is an effective therapeutic alternative for patients with localized prostatic adenocarcinoma.     

Transrectal high intensity focused ultrasound for the treatment of localized prostate cancer: factors influencing the outcome

OBJECTIVES: Efficacy evaluation of high intensity focused ultrasound (HIFU) treatment for localized prostate cancer and identification of the factors affecting the outcome. PATIENTS AND METHODS: 102 patients with prostate cancer stage T1-T2 and noncandidates for radical prostatectomy have been treated with HIFU (Ablatherm, EDAP-Technomed). The disease progression (failure) was strictly defined by any positive sample at control biopsies, whatever the prostate-specific antigen (PSA) level, or by 3 consecutive increases in PSA levels in case of negative biopsies. RESULTS: At inclusion, patients' baseline characteristics were (mean +/- standard deviation): age 70.8 (+/-6.13) years, PSA 8.38 (+/-4.8) ng/ml, prostate volume 33.3 (+/-16.71) cm3. The population mean follow-up was 19 months (3-76 months). The overall success rate was 66%. Statistically significant variations of the overall success with a more favorable outcome were observed when (1) the initial PSA level was < or =10 ng/ml (73 vs. 50%, p = 0.02), (2) the Gleason score was < or =6 (81 vs. 46%, p<0.001) and (3) the pretreatment sextant biopsy evidenced 1-4 positive samples (68 vs. 40%, p = 0.01). CONCLUSION: Results observed after HIFU treatment in localized prostate cancer are now challenging those obtained after radiation therapy. The success rate is influenced by disease-related prognostic factors.     

High-grade prostate cancer is associated with low serum testosterone levels

BACKGROUND: The aim of this study was to assess whether low serum testosterone levels in men with newly diagnosed prostate cancer have an association to the endocrine status, prostate-specific antigen (PSA) levels, Gleason score, and androgen receptor expression. METHODS: Besides a full clinical work-up, the following hormones were quantified in men with newly diagnosed prostate cancer by serum analysis: total testosterone, human luteinising hormone (hLH), human follicle stimulating hormone (hFSH), estradiol, and dehydroepiandrostendione (DHEA). In a subgroup of men, androgen receptor expression was determined immunohistochemically. RESULTS: One hundred and fifty six patients (65.7 +/- 8.5 yrs) with a mean PSA of 29.8 ng/ml (median: 7.4 ng/ml) were analysed. Fifty-two patients (33%) had a partial androgen deficiency (serum testosterone < 3.0 ng/ml). These men had lower hLH (3.3 vs. 5.9 mIU/ml), hFSH (6.2 vs. 8.4 mIU/ml), and estradiol (18.8 vs. 29.1 pg/ml) serum levels. Mean Gleason score was higher (7.4 vs. 6.2) in men with a low serum testosterone, PSA-levels were lower (25.3 vs. 31.9 ng/ml). Mean testosterone levels decreased from 4.1 +/- 1.7 ng/ml in patients with Gleason scores < or = 5 to 2.8 +/- 2.7 ng/ml with Gleason scores > or = 8. Androgen receptor expression was higher in patients with low serum testosterone. CONCLUSIONS: Patients with high Gleason score prostate cancer have lower testosterone and estradiol serum levels. The fact that gonadotropins were lower in parallel suggests a tumor-mediated suppression of the hypothalamic-pituitary-gonadal hormone axis particularly in men with high Gleason score tumours.     

High-intensity focused ultrasound therapy for clinically localized prostate cancer

The efficacy of high-intensity focused ultrasound (HIFU) used for the treatment of localized prostate cancers has been demonstrated over the past decade. We present our early results after HIFU used as a single session in patients with clinically localized prostate cancer. A total of 58 patients were treated using the Ablatherm HIFU device with or without transurethral resection of the prostate (TURP). HIFU failure was defined as the presence of a cancer remnant on repeated biopsies or three consecutive increases in the prostate-specific antigen (PSA) >/=1.0 ng/ml. The mean follow-up was 14 months (range, 6-21 months). After HIFU treatment, 78% of patients had a decreased PSA level to <0.5 ng/ml within 3 months. The median value of the last PSA was 0.6 ng/ml and the median nadir PSA was 0.2 ng/ml. The success rates of HIFU were 85, 77 and 47% in low-, intermediate- and high-risk groups, respectively. The HIFU failure rate was closely associated with clinical stage, presence of cancer on TURP chips and nadir PSA on univariate analysis. However, the only significant predictor for HIFU failure was the nadir PSA value by multivariate Cox regression analysis. The operation-related complications were minimal. Although both the period and number of patients were limited to evaluate the clinical efficacy, HIFU appears to be a safe and effective treatment option in selected patients with prostate cancer.     

First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer

OBJECTIVE: To evaluate the long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for patients with localised prostate cancer. MATERIAL AND METHODS: Patients included in this multicentre analysis had T1-T2 NxM0 prostate cancer, a PSA<15 ng/ml, and a Gleason score (GS) < or = 7, and were treated with prototypes or first-generation Ablatherm HIFU devices between October 1997 and August 2001. The Phoenix definition of biochemical failure was used (PSA nadir+2). Treatment failure was defined as: biochemical failure or positive biopsy. RESULTS: A total of 140 patients with a mean (SD) age 69.1 yr (6.6) were included. Mean (SD) follow-up was 6.4 yr (1.1). Control prostate biopsies were negative in 86.4% of patients. Median PSA nadir of 0.16 ng/ml (range, 0.0-9.1) was achieved at a mean (SD) of 4.9 mo (5.2). A PSA nadir < or = 0.5 ng/ml was recorded in 68.4% of patients. The actuarial biochemical failure-free survival rates (SR) at 5 and 7 yr were 77% and 69%, respectively. The actuarial disease-free SR at 5 and 7 yr were 66% and 59%, respectively. CONCLUSIONS: This study demonstrates the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate cancer.     

Transurethral resection of prostate just following high intensity focused ultrasound in localized prostate cancer--trial for early removal of the urethral catheter

We studied the impact of combined transurethral resection of the prostate (TURP) and high intensity focused ultrasound (HIFU) for localized prostate cancer (CaP) to decrease side effects such as prolonged urinary voiding disturbance observed after HIFU treatment. Included in this study were 18 patients with clinically localized CaP indicated for HIFU just followed by TURP (TUR combination group). Complete response was defined in accordance with ASTRO consensus statement and negative sample in biopsies performed 6 months after the HIFU treatment. Prostate specific antigen (PSA) nadir, International Prostate Symptom Score (IPSS) and morbidity during follow-up of TUR combination group were compared with those of a control of 18 patients who took HIFU treatment alone (HIFU monotherapy group). No statistical significances on the values of preoperative parameters (PSA, prostate volume, Gleason score, and IPSS) between these two groups. The median follow-up duration was 10 (5-15) months in both groups. A statistically significant impact was observed between TUR combination group and HIFU monotherapy group on median catheter time (5 versus 13 days, P<0.0001), PSA nadir (0.096 ng/ml versus 0.430 ng/ml in median, P<0.05) and the evolution of the post-treatment IPSS (8 versus 13.5 in median, P<0.0003) at 3 months after treatment. Urethral stricture necessary for urethral dilation was noted in 1 patient (5.6%) in the TUR combination group while in 2 (11.1%) in the HIFU monotherapy group. CR was obtained in 88.9% in the TUR combination group and 83.3% in the HIFU monotherapy group. Our study suggests that the combination of TURP with HIFU treatment improves posttreatment urinary status without additional morbidity.     

高强度聚焦超声联合内分泌综合治疗前列腺癌34例临床分析

目的评价应用高强度聚焦超声和内分泌治疗的综合治疗方案在前列腺癌治疗中的临床效果。方法对34例前列腺癌患者联合应用高强度聚焦超声和内分泌治疗,观察和统计治疗前后血前列腺特异性抗原、前列腺体积、前列腺彩超以及前列腺穿刺活检结果的变化,调查治疗后并发症的发生情况。结果34例患者治疗后血前列腺特异性抗原PSA（14．6±13．1）ng／mL,与治疗前（35．7±14．6）ng／mL相比,具有统计学显著性差异（P〈0．05）。前列腺体积治疗前（49．7±21．3）cm。,治疗后（42．1土11．6）cm^3,两者无统计学差异（P〉0．05）。前列腺再穿刺阴性率68．4％（13／19）患者前列腺再穿刺阴性。26例（76．5％）患者在拔除尿管后出现尿频、尿痛等排尿不适症状。11例（32．3％）出现轻度的血尿。结论联合应用高强度聚焦超声和内分泌治疗的综合治疗方案能有效地降低前列腺癌患者的PSA,临床治疗效果肯定,并发症少,安全性好,是一种比较合理的前列腺癌治疗方案。