老年中晚期前列腺癌患者内分泌综合治疗临床分析

Clinical analysis of the complex endocrine treatment for the elderly with prostate cancer at middle and late stages

目的探讨以雄激素阻断为主的综合治疗方法对中晚期前列腺癌的临床疗效。方法回顾总结2001年6月至2009年8月我院前列腺癌中晚期（T。期以上）患者63例，平均年龄69．4岁。临床采用单纯手术去势21例；单纯药物去势15例，亮丙瑞林3．75mg／月或诺雷德3．6mg／月，皮下注射，连续治疗1年；手术去势加用最大雄激素阻断（maximum androgen blockade，MAB）27例，比卡鲁胺50mg，1次／d，口服；或氟他胺250mg，3次／d，口服。比较生存率及血清前列腺特异性抗原（PSA）治疗前后的变化。结果1、2、3年生存率手术去势组为100．0％、90．0％、75．0％，药物去势组为100．0％、86．7％、73．3％，MAB组为100．0％、96．2％、84．0％；MAB治疗组3年生存率明显高于其余两组（x2=4．460，P〈0．05）。三组治疗后12个月PSA比治疗前均显著降低，尿流率比治疗前均显著增加（t=2．641，3．074，6．703，P〈0．01）；三组治疗后PSA比较差异无统计学意义；MAB治疗组缓解有效期明显长于其余两组（F=16．57，P〈0．01）结论MAB可作为中晚期前列腺癌的有效治疗方法，优于单纯去势治疗。

Objective To investigate the clinical effects of androgen blockade combined treatment for the elderly with middle and late prostate cancer. Methods 63 patients （average age of 69.3 years） with middle and late prostate cancer （above stage T3 ） were studied retrospectively from June 2001 to August 2009. 21 cases were treated by operation of bilateral orchidectomy independently. 15 cases were treated by castration independently （enantone 3.75 mg or zoladex 3.6 rag/month, hypodermic injection for one year）. 27 cases were treated by bilateral orchidectomy plus maximum androgen blockade （MAB） （bicalutamide 50 rag, qd, fulutimad 250 rag, rid, po. ） Results The survival rates of 1, 2, 3 years were 100.0%, 90.0%, 75.0% in operation group, 100.0%, 86.7%, 73.3% in drug group, and 100. 0%, 96.2%, 84.6%in MAB group, respectively. The survival rates of 3 years was higher in MAB group than the other groups（x2 =4. 460,P〈0.05）. The levels of PSA within 3 months decreased and urinary flow rates in three groups increased after treatment than before treatment （t= 2. 641,3. 074,6. 703, P〈0.01） with no differences among the groups. The relieve period of validity was longer in MAB group than in other groups （F= 16.57 ,P〈0.01）. Conclusions MAB may be more effective for the elderly with middle and late prostate cancer than castration therapy independently.