前列腺癌根治术前激素辅助治疗的临床评价(附26例报告)

Clinical evaluation on neoadjuvant hormonal deprivation before radical prostatectomy (Report of 26 cases)

目的:探讨前列腺癌根治术前辅以LHRH类药物治疗的临床意义。方法:26例经前列腺活检证实局限性前列腺癌,其中10例前列腺癌根治手术前辅以LHRH类药物治疗3个月,16例单纯行前列腺癌根治术,比较两组的临床特征。结果:26例行盆腔淋巴结清扫,阳性率3.8％(1/26);术后血清PSA值明显下降(P=0.0002);前列腺根治术后实体标本病理Gleason评分为(6.6±1.8)分。LHRH类药物治疗组10例,治疗后血清PSA明显降低(P<0.01),5例临床分期降低,术后前列腺尖部切缘残留癌4例,精囊浸润4例;前列腺癌单纯根治术组16例,无前列腺尖部切缘残留癌病例,精囊浸润6例。前列腺尖部切缘残留癌发生率两组差异有显著性意义(P=0.014),精囊浸润率两组差异无显著性意义(P=0.61)。结论:前列腺癌根治术为治疗局限性前列腺癌最有效的方法,术前辅以LHRH类药物治疗可降低前列腺癌的临床分期,对病理分期的影响有待进一步观察。

Purpose;To evaluate clinical significance of radical prostatectomy combined with preoperation neo-adjuvant hormonal ablative therapy. Method:26 patients proved as local prostate cancer by biopsies were performed by radical prostatectomy,in which 10 patients were given preoperative hormonal deprivation by taking a LHRH a-nalogy for a period of 3 months. Data were evaluated for clinical characteristics. Result: 26 patients received pelvic lymph node dissection and the rate of positive lymph nodes was 3. 8% (1/26). Value of Serum PSA decreased after radical prostatectomy ( P =0. 2X 10-3). Gleason score was 6. 6+ 1. 8 after radical prostatectomy. Serum PSA value decreased significantly in 10 cases and clinical stage decreased in such 5 patients with LHRH agonist therapy. There was significant difference in the positive surgical margins and no significant difference in the seminal vesicle invasion between LHRH agonist group in 10 patients and radical prostatectomy group in 16 patients (4/10 versus 0/16, P =0. 014, 4/10 versus 6/16, P =0. 61, respectively). Conclusion .-Radical prostatectomy was more effective method for treating local prostate cancer. Preoperative hormonal deprivation by taking a LHRH analogy could decrease clinical staging, but its influence on pathological staging needed more studies and further evaluation.