晚期前列腺癌膀胱出口梗阻内分泌治疗的价值

Hormonal therapy for lower urinary tract obstruction caused by advanced prostate cancer

目的探讨晚期前列腺癌BOO内分泌治疗（HT）的价值。方法晚期前列腺癌伴BOO患者52例，平均年龄72（54～76）岁。既往均未行HT。病程5个月～7年，平均3．6年。治疗前经直肠B超测定前列腺重量为（53．5±15．3）g；IPSS23．4±4．5；Qmax（4．8±2．5）ml／s；PSA（53．4±7．5）ng／ml。有尿潴留6例。52例治疗前均经直肠前列腺穿刺活检病理证实，Whitmore-Jewette临床分期：C期14例，D期38例。所有病例首先给予HT，对治疗3个月LUTS无改善者采用姑息性TURP治疗。结果HT后LUTS明显改善者占71％（37／52），治疗前后Qmax；分别为（6．2±4．5）和（13．0±5．5）ml／s、IPSS分别为24．1±5．3和7．8±2．0，治疗前后比较差异均有统计学意义（P〈0．05）；LUTS未见缓解者占29％（15／52），治疗前后Qmax分别为（6．6±4．3）和（7．0±4．2）ml／s、IPSS分别为23．6±5．1和22．5±4．9，治疗前后比较差异均无统计学意义（P〉0．05）。行姑息性TURP后好转12例，尿失禁3例，其中2例经肛提肌训练及药物治疗后有不同程度恢复。结论HT对大部分晚期前列腺癌患者BOO有明显疗效，并可使无改善者前列腺体积缩小，便于进一步治疗。

Objective To assess the role of hormonal therapy （HT） in the treatment of lower urinary tract obstruction （LUTS） caused by advanced prostate cancer （PCa）. Methods There were 52 patients with LUTS caused by advanced PCa treated with HT. The average age was 72 （54--76） years. They all had no history of HT. The pre-treatment transrectal ultrasound （TRUS） showed that the average prostate weight was 53.5 ±15.3 g;the average IPSS was 23.4 ± 4.5 ; the maximal urine flow rate （Qmax） was 4.8±2.5 ml/s;the PSA was 53.4±7.5 ng/ml. There were 6 cases with urinary retention. All cases had the TRUS guided prostate biopsy and pathological diagnosis. The clinical stages were： stage C 14 cases, stage D 38 cases. All the cases were treated with HT first, then they would be treated with channel TURP if LUTS was not improved . Results 71% （37/52） cases had significant LUTS improvement after the treatment of HT. The Qmax improved from 6.2±4.5 ml/s to 13.0±5.5 ml/s, IPSS improved from 24.1±5.3 to 7.8±2.0, P〈0.05, respectively. 29%（15/52） cases had no improvement in LUTS. The Qmax was 6.6 ± 4. 3 ml/s before treatment and 7.0 ± 4.2 ml/s after treatment, IPSS was 23.6± 5.1 before treatment and 22.5 ± 4.9 after treatment, respectively. Of whom, 15 cases accepted salvage channel TRUP, 12 had improved LUTS and 3 had developed incontinence. Conclusion HT is an efficient therapeutic option to relieve lower urinary tract obstruction caused by advanced PCa.