坦索罗辛在晚期前列腺癌伴膀胱出口梗阻中的应用价值

Tamsulosin application for the treatment of advanced prostate cancer accompanied with bladder outlet obstruction

目的探讨坦索罗辛治疗晚期前列腺癌伴发膀胱出口梗阻的临床疗效及安全性。方法 44例存在膀胱出口梗阻的下尿路症状(LUTS)症状晚期前列腺癌患者,22例(A组)最大限度雄激素阻断治疗(MAB)联合应用超选择性α1A受体阻滞剂坦索罗辛0.2mg,qn;22例(B组)单纯性MAB治疗。前瞻性地从国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)、最大尿流率(Qmax)、残余尿、前列腺体积、前列腺特异性抗原(PSA)等多个角度进行评估。结果两组间治疗前所有参数比较差异无统计学意义(P>0.05),治疗后两组IPSS、QOL、Qmax、残余尿等参数的改变均有统计学差异(P<0.05),A组患者IPSS、Qmax、QOL、残余尿等指标较B组更好,具有统计学差异(P<0.05),但前列腺体积及PSA指标未见明显差异,无统计学差异(P>0.05),两组未观察到明显的毒副作用。结论坦索罗辛可有效改善晚期前列腺癌伴膀胱出口梗阻患者下尿路症状,对无法耐受姑息性TURP患者明显提高生活质量,MAB联合坦索罗辛是一种安全而有效的治疗选择。

Objective To explore the pharmacological effectiveness and safety of tamsulosin for the combined therapy in the advanced prostate cancer associated with bladder outlet obstruction. Methods 44 patients suffered from advanced prostate cancer were treated, then were randomly divided into the treatment group and control group. The treatment group included 22 patients who were treated with maximal androgen blockade （MAB） and tamsulosin（0. 2 mg, qn）, otherwise, only maximal androgen blockade（MAB） were used in the control group. A prospective study was performed to evaluate the patients involved in the investigation from international prostate symptom score （ IPSS）, quality of life index scores, maximum urinary flow rate, prostate volume, post voiding residual （PVR） for about 4 or 8 weeks. Results At baseline there were no significant differences between the groups. After 4 and 8 weeks, the results showed that the IPSS, QOL, Qmax, PVR were significant decreased in the two groups after treatment（P 〈 0. 05） ,but treatment group were much improvement in patients taking tamsulosin compared with the control. However, the prostate volume andPSA variation had no significant difference （P 〉 0. 05 ）. No severe adverse effect was observed in the treatment group. Conclusions Tamsulosin is effective in improving lower urinary tract symptoms of advanced prostate cancer with bladder outlet obstruction, and significantly improve the quality of life of patients who can not tolerate palliative TURP. The combined use of MAB and tamsulosin is a safe and effective treatment option.