经尿道前列腺电切术联合全雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻的体会

The Experience of Transurethral Resection Combined with Maximal Androgen Blockade Therapy for Advanced Prostate Cancer with Bladder Outlet Obstruction

目的探讨经尿道前列腺电切术(TURP)联合全雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻的效果。方法对52例晚期前列腺癌伴膀胱出口梗阻患者采用TURP+间断全雄激素药物治疗。结果 52例手术均顺利,术后排尿困难均明显改善,术后3个月患者血清总前列腺特异性抗原(TPSA)较术前明显下降,最大尿流率(Qmax)较术前明显升高、残余尿量(RU)较术前明显减少、国际前列腺症状评分(IPSS)、生活质量评分(QOL)较术前明显改善(P均<0.05)。18例骨转移瘤患者骨痛显著减轻或消失。50例获得随访,随访4～65个月,46例患者长期带瘤生存,3例患者死于前列腺癌。结论 TURP联合间断全雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻的近期疗效确切,能明显改善患者膀胱出口梗阻症状,提高患者的生活质量。

Objective To evaluate the experience of transurethral resection（TURP） combined with maximal androgen blockade therapy for advanced prostate cancer with bladder outlet obstruction. Methods Fifty two patients with advanced prostate cancer with bladder outlet obstruction were treated with TURP and intermittent maximal androgen blockade therapy. Results Fifty two patients were oper- ated successfully, and postoperative voiding symptoms were significantly improved. Serum TPSA decreased greatly, maximum urinary flow rate （Qmax） was significantly higher, residual urine volume （RU） significantly reduced compared with that before the operation, and the international prostate symptom score（IPSS）, quality of life score（QOL） improved significantly compared with those before surgery （all P〈 0.01）. Bone pain of 18 patients with bone metastases was significantly reduced or even disappeared. All of 50 cases were followed up for 4 to 65 months, 46 of which patients had long-term survival, three patients died of prostate cancer. Conclusion TURP combined intermittent maximal androgen blockade therapy for advanced prostate cancer with bladder outlet obstruction is effective in the near future. It can significantly improve symptoms in patients with bladder outlet obstruction and improve patients＇ quality of life.