对高危局限性前列腺癌患者个体化综合治疗的体会(附1例报道并文献复习)

Individualized comprehensive treatment strategies for high risk of localized prostate cancer patients(one case report and literatures review)

目的提高对高危局限性前列腺癌个体化综合诊疗方式的认识。方法对1例高危局限型前列腺癌患者的临床资料及诊疗方案进行回顾、分析,并进行相关文献复习。此患者先后经历了最大限度雄激素阻断治疗、高强度聚焦超声前列腺消融、三维适型调强放疗、经直肠穿刺125I粒子植入、多西他赛联合强的松、口服磷酸雌莫司汀化疗和阿比特龙抗雄等综合治疗方式。结果患者于2006年9月查PSA 158.69ng/mL,经直肠前列腺穿刺病理确诊为前列腺低分化腺癌,Gleason评分5+4=9分,经综合治疗后,目前已进展为去势抵抗性前列腺癌,伴全身多发骨转移,予再次多西他赛联合强的松3周化疗方案,目前PSA较化疗前显著降低,体能状态较好,骨痛不适症状明显好转,仍在随访治疗中。结论对高危局限性前列腺癌患者采用个体化综合治疗策略,能推迟肿瘤的进展,提高患者的生存质量,值得临床进一步探讨。

Objective To improve the understanding of comprehensive treatment for high risk of localized prostate cancer.Methods One case high risk of localized prostate cancer of our hospital clinical, The clinical data and the results of the patients followed-up were retrospectively reviewed. experienced the maximum androgen blockade therapy, high intensity focused ultrasound ablation of the prostate, intensity modulated radiation therapy, transrectal prostate125I seeds implantation, docetaxel combined with prednisoney, oral estramustine and abiraterone comprehensive treatment.Results In September 2006, the patients admitted to hospital check PSA158.69 ng/mL, pathologic diagnosis of poorly differentiated adenocarcinoma of the prostate, Gleason score 5＋4= 9 points, the patient has now been progress for castration resistant prostate cancer, with multiple bone metastases, docetaxel combined with prednisoney 3 weeks scheme chemotherapy again, PSA reduced significantly than before treatment, bone pain symptoms improved significantly.Conclusion Individualized comprehensive treatment strategies for high-risk patients with localized prostate cancer can delay the progress of the tumor, and improve the patient＆39;s survival quality. It is worthy of clinical attention.