前列腺癌根治术前新辅助治疗效果分析

目的　探讨前列腺癌根治术前新辅助治疗的疗效。方法　 31例经前列腺活检证实为局限性前列腺癌患者 ,其中 12例于前列腺癌根治术前辅以诺雷德加氟他胺 (新辅助治疗组 )平均治疗 5 .6个月 ,19例单纯行前列腺癌根治术 (单纯根治术组 ) ,比较两组的临床特征。结果　两组患者的盆腔淋巴结清扫阳性率为 12 .9%(4 / 31例 ) ,术后血清前列腺特异性抗原 (PSA)水平明显下降 (P <0 .0 1)。新辅助治疗组药物治疗后血清PSA明显降低 (P <0 .0 1) ,8例临床分期降低 ,术后前列腺切缘阳性 2例 ,精囊浸润 1例 ,淋巴结转移 1例 ;单纯根治术组前列腺切缘阳性 7例 ,精囊浸润 4例 ,淋巴结转移 3例。两组的前列腺切缘阳性率、精囊浸润率、淋巴结转移率的差异有显著性 (P值均 <0 .0 5 ) ,而手术时间、失血量和Gleason评分的差异无显著性 (P值均 >0 .0 5 )。结论　前列腺癌根治术是治疗局限性前列腺癌最有效的方法 ,术前辅以新辅助治疗可降低前列腺癌的临床分期和病理分期 ,其对远期疗效的影响有待进一步观察。

Analysis of neoadjuvant hormonal deprivation for prostatic cancer before radical prostatectomy

Objective To evaluate the therapeutic effect of radical prostatectomy combined with preoperative neoadjuvant hormonal ablation therapy for prostatic cancer. Methods 31 patients proved to have localized prostate cancer by biopsies were undercome radical prostatectomy, including 12 patients with preoperative hormonal deprivation by Goserelin plus Flutamide for a period of 5.6 months. The data of clinical characteristics were compared.Results 31 patients received pelvic lymph node clearance and the rate of positive lymph nodes was 12.9%(4/31). Serum PSA decreased markedly after radical prostatectomy ( P <0.01) and also decreased significantly in 12 cases with preoperative hormond ablation therapy accompanied by reduced clinical staging in 8(after hormonal ablation theraphy). There were significant differences in the positive surgical margins, seminal vesicle invasion and lymph node metastasis between neoadjuvant therapy group ( n =12) and radical prostatectomy group( n=19,P < 0.01 ).Conclusion Radical prostatectomy is more effective for treating localized prostate cancer. Preoperative hormonal deprivation by given Goserelin plus Flutamide can decrease the clinical staging and pathological staging, but its influence on long term prognosis needs further observation.