氟他胺联合抑那通间歇性治疗手术去势后前列腺癌的临床观察

目的探讨晚期前列腺癌手术去势后间歇性雄激素阻断治疗的临床疗效。方法选取2003年1月至2010年1月晚期前列腺癌患者24例（C1、C2、D1、D2期分别为2、6、10、6例）,做睾丸去势手术后,采用间歇性内分泌治疗：氟他胺服用3～6个月,当前列腺特异性抗原（PSA）下降达到相对稳定水平（0.2～13μg/L）并维持2个月后停药,停药期间定期影像学检查及PSA监测,当PSA水平超过稳态水平2～3倍时进入下一周期氟他胺治疗,以此类推;抑那通在手术去势后18～24个月,当PSA大于稳态水平2～3倍时开始使用,1次/月,3次/疗程,以后每3年1疗程。结果 24例患者平均随访时间（38.7±14.3）月,22例生存,生存率91.7%;3例氟他胺耐药。停药间歇期〉9个月,87.5%患者重复用药后仍能有效控制,重复用药后平均治疗时间（5.0±1.1）月。与单纯手术去势或持续内分泌药物治疗比较,间歇性内分泌治疗可明显延长肿瘤对雄激素依赖的时间。结论手术去势后联合间歇性内分泌治疗,可延缓患者向雄激素难治性前列腺癌的进展,是治疗晚期前列腺癌的有效方法

Clinical study of intermittent therapy with flutamide and enanton on advanced prostate cancer after castration

Objective To investigate the efficacy of intermittent hormonal androgen-block therapy（IHT） in the treatment of advanced prostate cancer after castration. Methods A total of 24 patients with advanced prostate cancer （C1-,C2-,D1-,D2-stage were 2,6,10,6 cases,respectively）underwent castration between January 2003 and January 2010 were treated with IHT including flutamide and enanton.Flutamide （eachtime 250 mg） was taken three times a day for 3-6 months and stopped until the serum prostate specific antigen （PSA） was decreased to homeostasis level （0.2-13 μg/L） and lasted for two months.During stopping flutamide,imaging examination and PSA detection were carried out regularly,and when PSA level was more than 2-3 times of homeostasis level the next flutamide therapy was given.When PSA level was more than 2-3 times of homeostasis level in 18-24 months after castration,enanton was administration （3.75 mg/month,subcutaneous injection,3 times a course,every 3 years the course was repeated）. Results The average follow-up time was （38.7±14.3） months.The survival rate was 91.7%（22/24）.Flutamide resistance happened in 3 cases.The interval time of stopping drug was more than 9 months,and about 87.5% of patients could be effectively controlled by using flutamide again.The average time of treatment was （5.0±1.1） months after renewing use of flutamide.Compared with signal orchiedectomy or continuous hormonal therapy,IHT could obviously delay the time of dependence of tumor on androgen. Conclusions IHT could obviously delay the progress of prostate cancer towards refractory prostate cancer of androgen independence.It is an effective method for patients with advanced prostate cancer after castration