晚期前列腺癌综合治疗的初步疗效分析

目的 :探讨晚期前列腺癌综合治疗的方法。　方法 :对 1991年 5月～ 1997年 7月收治的 6 2例晚期前列腺癌 (C期和D期 )病人的治疗结果进行分析。 33例前列腺症状评分 (IPSS) <15的前列腺癌病人 (I组 )行去势术 +缓退瘤。 2 9例IPSS≥ 15的病人 (Ⅱ组 )行经尿道前列腺电切 (TURP) +去势术 +缓退瘤。内分泌治疗期间梗阻症状明显加重者再次行TURP。　结果 :治疗后所有病人的主观症状均较治疗前明显改善 ,最大尿流率 (MFR)增加、剩余尿减少、PSA值明显下降。 34例病人在治疗期间 (治疗 16～ 39个月后 )转变为激素非依赖性前列腺癌 ,经停用缓退瘤 ,改用癌腺治或酮康唑治疗 ,17例 (5 0 % )病人得到不同程度的缓解。　结论 :对IPSS≥ 15的晚期前列腺癌病人 ,TURP可有效地减少尿道梗阻所致的并发症 ,配合内分泌治疗效果良好 ,无严重并发症 ;对激素非依赖性前列腺癌 ,停用缓退瘤 ,改用酮康唑或癌腺治治疗 ,可取得一定疗效。

Evaluation of the Efficacy of Combined Therapy in Treating Advanced Prostate Cancer

Objectives: To study the combined therapy for advanced prostate cancer. Methods: From May 1991 to July 1997, 62 cases of advanced prostate cancer were treated with combined therapy. Group 1 including 33 cases with international prostate symptom score (IPSS)<15 was treated with orchiectomy plus oral flutamide. Group 2 including 29 cases with IPSS≤15 was treated with TURP plus orchiectomy plus flutamide. Results: After treatment, the subjective symptoms improved, MFR increased and residual urine decreased significantly ( P <0.01) The PSA decreased significantly in both groups after treatment ( P <0.01) . 16～39 months after initial treatment, 34 patients developed into hormone independent prostate cancer and were treated with ketoconazole or estracyte. Conclusions: TURP combined with endocrine therapy was effective and caused no severe complications in those cases with IPSS≥15. Ketoconazole and estracyte were to a certain extent effective in treating hormone independent prostate cancers.