Gleason 10分前列腺癌患者的临床特点分析

Clinical characteristic of Gleason 10 prostate cancer

目的观察Gleason 10分前列腺癌患者的临床诊疗及疾病变化过程，总结该类前列腺癌患者的临床特点及预后影响因素。方法2005年1月至2010年5月，21例初诊为前列腺癌、Gleason 10分、行手术去势加抗雄激素治疗的患者纳入本研究。初诊年龄56～85岁，平均73岁。PSA8．9～261．0．g／ml，平均60．8ng／ml，其中6例PSA≤20ng／ml。行核素骨扫描发现骨转移16例。予双侧睾丸切除术加氟他胺或比卡鲁胺全雄激素阻断治疗。术后1个月复查PSA，以后每3个月随访PSA。治疗后6个月为单纯内分泌治疗观察终点。6个月内PSA未降至〈4ng／ml且无远处转移者加用局部外放射治疗，伴骨转移者使用基于多西他赛与泼尼松的全身化疗。患者死亡为研究终点。结果15例初诊PSA〉20ng／ml患者中，5例治疗后6个月内血清PSA未降至正常水平，其中4例伴骨转移。该4例予全身化疗后PSA均未降至正常水平，3例1年内死亡，1例诊断后19个月死亡，1例疾病局限患者予外放射治疗，PSA下降至正常水平8个月后出现肿瘤进展，诊断后11个月死亡。10例治疗后6个月内血清PSA降至正常水平，其中3例分别于诊断后第19、28、36个月死于肿瘤，7例存活。6例初诊时PSA≤2．0ng／ml患者中3例治疗后6个月内PSA未降至正常水平，其中2例伴骨转移予化疗后于1年内死亡；1例PSA下降至正常水平但仍出现肿瘤进展，全身多发骨转移，化疗无效，1年内死亡；1例4年后因前列腺癌死亡；1例随访6个月，PSA降至0．07ng／ml。结论Gleason 10分前列腺癌肿瘤进展迅速，抗雄激素治疗疗效不佳，行全雄激素阻断后6个月内PSA无法下降至正常水平患者病情进展凶险。初诊PSA≤20ng／ml且病理证实Gleason 10分者可能预示预后不佳。

Objective To observe the clinical characteristic and treatment response of the Gleason 5 ＋ 5 prostate cancer and to summarize the prognostic factor of such patients. Methods From January 2005 to May 2010, 21 cases of Gleason 5 ＋ 5 prostate cancer were enrolled in this study. The average age was 73 years and the pre-treatment PSA was 60.8 ng/ml. Six of the 21 cases had a PSA level≤20 ng/ml. The maximal androgen deprivation therapy （ADT） in the form of castration and Casodex or fluetamide was carried out once the diagnosis was made. Bone metastasis was revealed in 16 cases. PSA levels were tested at the 4th month and then every 3 months after the castration. The observation endpoint was 6 months. Extracorporeal beam irradiation or the systemic chemotherapy was carried out if the PSA did not drop to a nor- mal range after 6 months. Results In the study group with initial PSA 〉 20 ng/ml, the PSA did not drop to normal range in 5 cases ; of which 4 had bone metastasis. With systemic chemotherapy, 3 cases died within 1 year. Another case, with localized disease, received an extracorporeal beam irradiation and died within 1 year due to progression of the tumor. Among the remaining 10 cases sensitive to total androgen blockage, 7 survived through the end of the study period. One case had PSA recurrence in month seven after the initialtherapy and died at month 19. One case had PSA recurrence at month 22 and died at month 36. The patient had his PSA augmented at month 24 after total androgen blockage and the patient passed away 4 months later. Of the 6 cases who had an initial PSA ≤20 ng/ml 4 died within one year. Conclusions Gleason 5 ＋ 5 prostate cancer is relatively resistant to ADT with a worse prognosis, especially for the cases with a nadir PSA 〉 4 ng/ml after 6 months＇ ADT. The patients who had an initial PSA ≤ 20 ng/ml might have an unsatisfactory clinical outcome.