转移性去势抵抗性前列腺癌多学科临床讨论

Multidisciplinary discussion of a patient with metastatic castration resistant prostate cancer

目的:探讨转移性去势抵抗性前列腺癌(metastatic castration resistant prostate cancer,m CRPC)多学科协作体系(multidisciplinary treatment,MDT)的诊治流程。方法:分析2017年12月上海交通大学医学院附属新华医院收治的1例m CRPC患者的MDT诊疗过程。患者经MDT讨论后采用阿比特龙联合唑来膦酸治疗,辅以左股骨下段转移病灶局部放疗,并密切监测前列腺特异性抗原(prostate specific antigen,PSA)变化及治疗不良反应。结果:治疗后患者PSA逐渐下降,4个月后随访总前列腺特异性抗原(total prostate specific antigen,t PSA)已下降至1.29 ng/m L,且无明显相关不良反应。结论:个体化治疗是m CRPC未来的发展趋势,平衡疗效和不良反应是临床医生应重点考虑的问题。采取MDT有利于制定规范化、个体化的治疗方案,针对m CRPC患者探索更有效的治疗方法可让更多患者获益。

Objective： To explore the multidisciplinary diagnosis and treatment workflow for a patient with metastatic castration resistant prostate cancer（m CRPC）. Methods： The diagnosis and treatment process of a patient with m CRPC, which were rectived in December 2017 at the Xinhua Hospital Affiliated to Shanghai Jiaotong University, were analyzed. Abiraterone acetate and zoledronic acid as well as the local radiotherapy that targeted the distal region of the left femur were selected as therapeutic regimen, after multidisciplinary treatment（MDT） discussion. Variation of serum prostate specific antigen（PSA） levels and treatment related side effects were monitored. Results： PSA levels gradually declined during the treatment. After a consecutive 4-month follow-up, the serum total PSA（t PSA） levels decreased to 1.29 ng/m L. No severe side effects were recorded. Conclusions： Individual and standard treatment will be the best choice for treating patients with m CRPC. Clinicians should consider how to balance curative effects and treatment-related side effects. MDT will facilitate clinical decision-making and benefit patients.