地加瑞克联合阿帕他胺用于极高危前列腺癌新辅助治疗1例报道

Efficacy of the degarelix plus apalutamide neoadjuvant therapy in a very high-risk prostate cancer patient prior to radical prostatectomy

探讨极高危前列腺癌(very high-risk prostate cancer,VHRPCa)采用新型内分泌药物新辅助治疗后给予根治性前列腺切除术(radical prostatectomy,RP)的疗效。患者男,61岁,因“进行性排尿困难,夜尿增多4年,加重半年”就诊。总前列腺特异性抗原(total prostate specific antigen,tPSA)89.16μg/ml。磁共振成像示前列腺大小5.2 cm×4.6 cm×4.2 cm,右侧外周带前列腺癌累及中央带;直肠受侵,前列腺影像报告和数据评分系统评分为5分;膀胱左后方及上方多发淋巴结增大。穿刺活检示前列腺癌,Gleason评分5+5=10分;骨扫描未见明显异常。采用新型内分泌药物阿帕他胺+地加瑞克新辅助治疗9个月后复查tPSA为0.05μg/ml;磁共振成像见前列腺体积缩小。给予RP+盆腔淋巴结清扫,术中粘连明显,平面欠清晰。术后病理Gleason评分5+4=9分,切缘和淋巴结均为阴性。术后维持原新辅助方案继续辅助治疗1年后,tPSA为0μg/ml;磁共振成像和发射型计算机断层扫描成像未见异常,故改为单纯雄激素剥夺疗法(androgen deprivation therapy,ADT)继续维持治疗,疗效满意。

The purpose of this study was to investigate the clinical effect for very high-risk prostate cancer(VHRPCa)patients treated with the novel endocrine neoadjuvant therapy prior to radical prostatectomy(RP).A 61-year-old man was admitted to hospital for dysuria and nocturia.Total prostate specific antigen(tPSA)was 89.16μg/ml.Magnetic resonance imaging:the prostate size was5.2 cm×4.6 cm×4.2 cm,and the right peripheral band involved the central band.Rectal invasion,prostate imaging reporting and data system score was 5.Multiple enlarged lymph nodes in the left posterior and superior bladder.Needle biopsy showed prostate cancer,Gleason score was 5+5=10.Bone scans showed no significant abnormalities.tPSA was 0.05μg/ml after 9 months of apaltamide and digreck neoadjuvant therapy.Magnetic resonance imaging showed reduced prostate volume.RP and pelvic lymph node dissection were performed.The intraoperative adhesion was obvious and the plane was not clear.The postoperative pathological Gleason score was 5+4=9,and the incisal margin and lymph nodes were negative.After 1 year of continued adjuvant therapy,tPSA was 0μg/ml.No abnormalities were found in magnetic resonance imaging and emission computed tomography.Androgen deprivation therapy(ADT)was continued.The curative effect is satisfactory.