Radioiodine therapy for castration-resistant prostate cancer following prostate-specific membrane antigen promoter-mediated transfer of the human sodium iodide symporter

Radioiodine therapy, the most effective form of systemic radiotherapy available, is currently useful only for thyroid cancer because of the thyroid-specific expression of the human sodium iodide symporter （hNIS）. Here, we explore the efficacy of a novel form of gene therapy using prostate-specific membrane antigen （PSMA） promoter-mediated hNIS gene transfer followed by radioiodine administration for the treatment of castration-resistant prostate cancer （CRPC）. The androgen-dependent C33 LNCaP cell line and the androgen-independent C81 LNCaP cell line were transfected by adenovirus. PSMA promoter-hNIS （Ad.PSMApro-hNIS） or adenovirus.cytomegalovirus-hNIS containing the cytomegalovirus promoter （Ad.CMM-hNIS） or a control virus. The iodide uptake was measured in vitro. The in vivo iodide uptake by C81 cell xenografts in nude mice injected with an adenovirus carrying the hNIS gene linked to PSMA and the corresponding tumor volume fluctuation were assessed. Iodide accumulation was shown in different LNCaP cell lines after Ad.PSMApro-hNIS and Ad.CMV-hNIS infection, but not in different LNCaP cell lines after adenovirus.cytomegalovirus （Ad.CMV） infection. At each time point, higher iodide uptake was shown in the C81 cells infected with Ad.PSMApro-hNIS than in the C33 cells （P 〈 0.05）. An in vivo animal model showed a significant difference in 1311 radioiodine uptake in the tumors infected with Ad.PSMApro-hNIS, Ad.CMV-hNIS and control virus （P 〈 0.05） and a maximum reduction of tumor volume in mice infected with Ad.PSMApro-hNIS. These results show prostate-specific expression of the hNIS gene delivered by the PSMA promoter and effective radioiodine therapy of CRPC by the PSMA promoter-driven hNIS transfection.

Outcomes of T3a Prostate Cancer with Unfavorable Prognostic Factors Treated with Brachytherapy Combined with External Radiotherapy and Hormone Therapy

Objective To evaluate the outcomes of T3 a prostate cancer with unfavorable prognostic factors treated with permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy.Methods From January 2003 to December 2008,38 patients classified as T3 a prostate cancer with unfavorable prognostic factors were treated with trimodality therapy(brachytherapy + external radiotherapy + hormone therapy).The prescription dose of brachytherapy and external radiotherapy were 110 Gy and 45 Gy,respectively.The duration of hormone therapy was 2-3 years.The endpoints of this study included biochemical failure-free survival(BFFS),distant metastasis-free survival(DMFS),cancer-specific survival(CSS),and overall survival(OS).Survival curves were calculated using the Kaplan-Meier method.The Log-rank test was used to identify the prognostic predictors for univariate analysis.Results The median follow-up was 71 months.The serum pre-treatment prostate-specific antigen(PSA) level ranged from 10.0 to 99.8 ng/ml(mean 56.3 ng/ml),the Gleason score ranged from 5 to 9(median 8),and the percentage of positive biopsy cores ranged from 10% to 100%(mean 65%).The 5-year BFFS,DMFS,CSS,and OS rates were 44%,69%,82%,and 76%,respectively.All biochemical failures occurred within 40 months.The percentage of positive biopsy cores was significantly correlated with BFFS,DMFS,and OS(all P=0.000),and the Gleason score with DMFS(P=0.000) and OS(P=0.001).Conclusions T3 a prostate cancer with unfavorable prognostic factors presents not so optimistic outcome.Hormone therapy should be applied to prolong the biochemical progression-free or metastasis-free survival.The percentage of positive biopsy cores and the Gleason score are significant prognostic factors.

Kinetics of testosterone recovery in clinically localized prostate cancer patients treated.with radical prostatectomy and subsequent short-term adjuvant androgen deprivation therapy

deprivation therapy （ADT） is a standard treatment for metastatic, recurrent and locally advanced prostate cancer （PCa）. The aim of this study is to investigate the timing and extent of testosterone recovery in clinically localized PCa patients treated with radical prostatectomy （RP） and subsequent short-term adjuvant ADT. A total of 95 localized PCa patients underwent RP and 9-month adjuvant ADT were included in this prospective study. Serum testosterone level was measured before adjuvant ADT, at ADT cessation, and at 1, 3, 6, 9 and 12 months after cessation of ADT. A Cox proportional hazards model was used to assess variables associated with the ti me of testosterone normalization. The results showed that median patient age was 67 years and median testosterone level before adjuvant ADT was 361 （230-905） ng d1-1. All patients finished 9-month adjuvant ADT and achieved castrate testosterone level. At 3 months after ADT cessation, testosterone recovered to supracastrate level in 97.9% patients and to normal level in 36.9% patients. The percentage of patients who recovered to normal testosterone level increased to 66.3%, 86.3% and 92.6% at 6, 9 and 12 months, respectively. Cox regression model found that higher baseline testosterone level （ 300 ng dl- 1） was the only variable associated with a shorter time to testosterone normalization （hazard ratio： 1.98; P -- 0.012）. In conclusion, in most patients, testosterone recovered to supracastrate level at 3 months and to normal level at 12 months after 9-month adjuvant ADT cessation. Patients with higher baseline testosterone level need shorter time of testosterone normalization.

Adjuvant radiotherapy for pathologically advanced prostate cancer improves biochemical recurrence free survival compared to salvage radiotherapy

AIM: To evaluate the long-term outcomes of patients receiving adjuvant and salvage radiotherapy following prostatectomy with adverse pathologic features and an undetectable prostate specific antigen(PSA).METHODS: A retrospective review was performed of patients who received post-prostatectomy radiation at Loyola University Medical Center between 1992 and 2013. Adverse pathologic features(Gleason score ≥ 8, seminal vesicle invasion, extracapsular extension, pathologic T4 disease, and/or positive surgical margins) and an undetectable PSA following prostatectomy were required for inclusion. Adjuvant patients received therapy with an undetectable PSA, salvage patients following biochemical recurrence(BCR). Post-radiation BCR, overall survival, bone metastases, and initiation of hormonal therapy were assessed. Kaplan-Meier time-to-event analyses and stepwise Cox proportional hazards regression(HR) were performed. RESULTS: Post-prostatectomy patients(n = 134) received either adjuvant(n = 47) or salvage(n = 87) radiation. Median age at radiotherapy(RT) was 63 years, and median follow-up was 53 mo. Five-year post-radiation BCR-free survival was 78% for adjuvant vs 50% salvage radiotherapy(SRT)(Logrank P = 0.001). Patients with radiation administered following a detectable PSA had an increased risk of BCR compared to undetectable: PSA > 0.0-0.2: HR = 4.1(95%CI: 1.5-11.2; P = 0.005); PSA > 0.2-1.0: HR = 4.4(95%CI: 1.6-11.9; P = 0.003); and PSA > 1.0: HR = 52(95%CI: 12.9-210; P < 0.001). There was no demonstrable difference in rates of overall survival, bone metastases or utilization of hormonal therapy between adjuvant and SRT patients. CONCLUSION: Adjuvant RT improves BCR-free survival compared to SRT in patients with adverse pathologic features and an undetectable post-prostatectomy PSA.

Cooperative Therapeutic Effects of Herpes Simplex Virus Thymidine Kinase Gene/Ganciclovir System and Chemotherapeutic Agents on Prostate Cancer in vitro

The killing effects of herpes simplex virus thymidine kinase gene/ganciclovir （HSV-tk/GCV） approach by the addition of several commonly clinical chemotherapeutic agents on hormone refractory prostate cancer （HRPC） cells PC-3m were investigated. After transferring of the HSV-tk gene into PC-3m cells, mRNA and protein expression of HSV-tk was detected by reverse-transcript polymerase chain reaction （RT-PCR） and strept avidin-biotin complex （SABC） im- munohistochemical method. The killing effect of GCV, cisplatin （CDDP）, etoposide （VP-16）, vincristine （VCR）, methotrexate （MTX）, 5-fluorouracil （5-Fu）, and suramin on PC-3m cells was evaluated by morphological assessment analysis, trypan blue exclusion assay and MTT assay respectively. Additionally, the cooperative effect of HSV-tk/GCV system combined with the above agents on the target cancer cells was determined by MTT. Furthermore, apoptosis and necrosis induced by GCV plus 5-Fu or suramin was analyzed by flow cytometry （FCM）. The results showed that that there was HSV-tk mRNA and protein expression in pDR2-tk plasmid transduced PC-3m cell. Combination of GCV with VP-16, VCR, 5-Fu or suramin led to an enhanced cellular killing effect, but with CDDP resulted in a reduced one and with MTX in an approximate one. FCM revealed that synergistic use of GCV and 5-fu or suramin resulted in a rather large proportion of apoptosis and necrosis with the apoptosis index being 36.38 % and 35.51%, and the proportion of necrosis being 33.05 % and 28.87 %, respectively. In conclusion, HSV-tk/CGV approach by addition of certain clinical available chemotherapeutic drugs brings on statistically significant enhanced cell killing over single-agent treatment. Our results highlight the potential for such new combination therapies for future treatments of HRPC.

The Effect of Obesity and Diabetes on Intermediate to High Grade Prostate Cancer Patients Treated with Radical Prostatectomy

Aims: The relationships between obesity, diabetes and prostate cancer are unclear. A retrospective study was performed to determine the effects of body mass index (BMI) and diabetes on patients with intermediate to high grade prostate cancer treated with radical prostatectomy. Methods: We reviewed 582 patients with Gleason score ≥ 7 non-metastatic prostate cancer treated with radical prostatectomy. Patients were stratified by BMI. End points were biochemical failure free survival (BFFS), overall survival (OS), and cancer specific survival (CSS). Results: Mean pre-treatment PSA decreased with increasing BMI (12.5, 7.6, 7.8 and 5.3 ng/mL with BMI 35, respectively;p 35, respectively. However, for overall mortality the adjusted hazard ratio was 0.39 (0.18, 0.82;p = 0.01) for overweight patients (BMI 25 - 30) compared to patients with a BMI in the normal range. Patients with a BMI of 30 - 35 and > 35 had increased rates of positive margins than those with a BMI of 25 - 30 or 35 2.04) on multivariate analysis, margin positivity alone was not a significant factor. Conclusions: Patients with increasing BMI tend to have a lower PSA at diagnosis but are more likely to have biochemical failure after radical prostatectomy. In our cohort, this was not due to the increased incidence of positive margins. Having diabetes had no effect.

Erectile function after WSTll vascular-targeted photodynamic therapy for low-risk prostate cancer treatment

Vascular-targeted photodynamic therapy(VTP)using padeliporfin is currently assessed as a low-risk prostate cancer(LRPCa)treatment.The aim of this study was to assess erectile function outcomes of VTP for LRPCa treatment.We prospectively included all patients treated with VTP for LRPCa.The primary endpoint was the post-treatment International Index of Erectile Function score(IIEF5 score)evolution(at 6 months,12 months,and then every year for 5 years).Secondary endpoints were the need of erectile dysfunction(ED)treatment and its efficacy.Eighty-two men were included.The median follow-up was 68(range:6-89)months.There was a 3-point significant decrease in the median IIEF5 score between baseline and at 6 months post-VTP(23[range:1-25]vs 20[range:1-25],P=0.005).There was a 1-point decrease at 1 year and 2 years post-VTP compared to baseline(22[range:2-25]and 22[range:0-25],P<0.005).There was no significant difference at 3,4,and 5 years compared to baseline.Twenty-seven(32.9%)patients received ED treatment:phosphodiesterase type-5 inhibitors(PDEI5;n=18),intracavernous injections(ICI;n=9),and intra-urethral gel(n=1).The median IIEF5 score statistically significantly increased after ED treatment(7[range:0-24]vs 21[range:1-25],P<0.001).ED treatment was efficient for 75%of the patients.There was no statistically significant difference between IIEF5 score at baseline and after ED treatment(P=0.443).Forty-six patients were totally potent before VTP and among them,13 needed ED treatment post-VTP with a success rate of 69.2%.VTP induced minimal changes in erectile function with a 3-point and a 1-point reduction in the IIEF5 score at 6 months and at 1 year,respectively.When required,ED treatment was efficient.

Focal therapy for localized prostate cancer:is there a “middle ground” between active surveillance and definitive treatment?

In recent years,it has come a long way in the diagnosis,treatment,and follow-up of prostate cancer.Beside this,it was argued that definitive treatments could cause overtreatment,particularly in the very low,low,and favorable risk group.When alternative treatment and follow-up methods are being considered for this group of patients,active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era.However,it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up.In the light of technological developments,the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet.According to the initial results,it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient.Thus,focal therapies have begun to find their"middle ground"place between definitive therapies and active follow-up.

Complete androgen blockade vs.medical castration alone as adjuvant androgen deprivation therapy for prostate cancer patients following radical prostatectomy:a retrospective cohort study

Background:Till date,the optimal treatment strategy for delivering adjuvant androgen deprivation therapy(ADT)in localized and locally advanced prostate cancer(PCa),as a lower stage in PCa progression compared with metastatic PCa,is still unclear.This study compares the efficacy of castration alone with complete androgen blockade(CAB)as adjuvant ADT in patients with localized and locally advanced PCa undergoing radical prostatectomy(RP).Methods:Patients diagnosed with PCa,without lymph node or distant metastasis,who received RP in West China Hospital between January 2009 and April 2019,were enrolled in this study.We performed survival,multivariable Cox proportional hazard regression,and subgroup analyses.Results:A total of 262 patients were enrolled,including 107 patients who received castration alone and 155 patients who received CAB.The survival analysis revealed that there was no significant difference between the two groups(hazard ratios[HR]=1.07,95%confidence intervals[95%CI]=0.60-1.90,P=0.8195).Moreover,the multivariable Cox model provided similarly negative results before and after adjustment for potential covariant.Similarly,there was no significant difference in the clinical recurrence between the two groups in both non-adjusted and adjusted models.Furthermore,our subgroup analysis showed that CAB achieved better biochemical recurrence(BCR)outcomes than medical castration alone as adjuvant ADT for locally advanced PCa(P for interaction=0.0247,HR=0.37,95%CI=0.14-1.00,P=0.0497).Conclusion:Combined androgen blockade achieved better BCR outcomes compared with medical castration alone as adjuvant ADT for locally advanced PCa without lymph node metastasis.

内分泌治疗联合经尿道前列腺电切术治疗晚期前列腺癌的临床观察

目的研究晚期前列腺癌患者行内分泌治疗联合经尿道前列腺电切术治疗的临床疗效。方法选取2012年1月—2013年2月收治的晚期前列腺癌患者60例,按照治疗方法分为对照组和观察组,每组30例。两组均行经尿道前列腺电切术加双侧睾丸切除术治疗,观察组在此基础上联合内分泌治疗。观察两组治疗前后前列腺特异抗原(PSA)水平、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流量及残余尿量,同时比较两组3年生存情况及不良反应。结果术后,拔出导尿管后可自行排尿患者40例,能进行适当功能训练患者15例,出现充盈性尿失禁状况患者5例。治疗后观察组PSA水平、IPSS评分及残余尿量均低于治疗前和对照组(P<0.05),QOL评分和最大尿流量均高于治疗前和对照组(P<0.05)。观察组1年、2年和3年生存率均高于对照组(P<0.05);两组在治疗期间均未出现明显不良反应。结论对于晚期前列腺癌患者在经尿道前列腺电切术治疗的基础上加用内分泌治疗能更好地改善病情,提高3年生存率。

年轻前列腺腺癌的临床诊治经验:10例报告

目的:前列腺腺癌是老年男性常见的恶性肿瘤,年轻男性前列腺腺癌较为罕见,本研究回顾10例年龄小于50岁的前列腺腺癌的临床诊治经验。方法:从2007年1月至2012年4月,共收治10例年龄小于50岁的前列腺腺癌患者,患者年龄36～49岁,均经前列腺穿刺活检病理确诊前列腺腺癌。4例患者前列腺特异抗原(prostaticspecific antigen,PSA)升高,7例患者直肠指诊阳性。穿刺病理Gleason评分为6分的有1例,7分有4例,9分有5例。临床分期为T2的有2例,T3有1例,T4有7例,淋巴结转移的有5例,骨转移的有4例。5例患者采用内分泌治疗,2例患者进行前列腺根治性切除术,3例采用综合治疗。结果:随访中,6例患者在治疗后3～7个月出现疾病进展,行进一步治疗,1例患者在治疗3年后因前列腺癌死亡。结论:年轻前列腺癌患者确诊时肿瘤分期较晚,恶性程度较高,治疗方法需要个体化,采用综合治疗。

全反式维甲酸提高激素非依赖性前列腺癌自杀基因治疗的旁观者效应

目的:观察全反式维甲酸(ATRA)提高单纯疱疹病毒胸苷激酶(HSV-TK)/丙氧鸟苷(GCV)系统体内外抗激素非依赖性前列腺癌的旁观者效应。方法:应用四甲基偶氮唑蓝(MTT)法测定细胞存活率来反映ATRA处理前后HSV-TK/GCV系统治疗PC-3细胞的旁观者效应;荷前列腺癌裸鼠模型随机分为4组,观察各组移植瘤生长状态和组织病理学改变。结果:在达到明显旁观者效应时,HSV-TK/GCV需要TK+PC-3细胞数为50%,而ATRA联合HSV-TK/GCV需要TK+PC-3细胞数仅为30%,两者比较差异显著(P<0.05)。HSV-TK可以抑制移植瘤生长,但ATRA+HSV-TK抗前列腺癌发生显效可提前1周,而且效果更显著(P<0.05)。结论:ATRA可增强HSV-TK/GCV系统治疗激素非依赖性前列腺癌的旁观者效应。

激素难治性前列腺癌组织中雄激素受体蛋白表达的研究

背景与目的:近来有研究报道,在激素难治性前列腺癌(hormonerefractoryprostatecarcinoma,HRPC)中发现有雄激素受体(androgenreceptor,AR)基因扩增,并提出AR基因扩增可能是导致激素治疗失败的一个新的分子机制。本研究拟对前列腺癌在激素治疗前和治疗失败后的AR蛋白表达作定量测定,进一步探讨AR表达与HRPC发生的关系。方法:采用放射配体结合分析方法测定28例晚期前列腺癌患者在激素治疗前以及治疗失败后原发癌组织中的AR蛋白含量。结果:28例前列腺癌在治疗前、后癌组织中的AR蛋白平均水平分别为(390.0±204.1)和(690.4±444.0)fmol/mgProtein,两者间差异有显著性(P<0.001)。其中10例在治疗后12个月内复发,其AR蛋白平均水平在治疗前、后分别为(398.2±199.5)和(448.2±274.1)fmol/mgProtein两者间差异无显著性(P>0.20),其余18例的AR蛋白平均水平在治疗前、后分别为(386.4±212.3)和(824.9±468.6)fmol/mgProtein,两者间差异有显著性(P<0.001)。结论:AR蛋白水平升高可能是前列腺癌对激素治疗不敏感的原因之一。

局限性前列腺癌间歇性内分泌治疗的临床观察

目的探讨间歇性内分泌治疗(IHT)局限性前列腺癌的效果。方法选取局限性前列腺癌(T1-2N0M0)患者36例,全雄激素阻断治疗6～9个月,停药时机为前列腺特异性抗原(PSA)≤0.2 ng/mL后持续3～6个月,以后根据每月PSA的检测结果决定是否再行内分泌治疗。治疗期及间歇期检测血清睾酮值,并行生活质量评分。结果 36例患者间歇性内分泌治疗6个月后血清PSA均降至正常,前列腺体积明显缩小。第1～5疗程的平均间歇期分别为5.8、6.6、8.4、5.6和3.0个月。最低PSA值从第1疗程的0.001 ng/mL上升至第5疗程的0.5 ng/mL。95.6%患者在第1个间歇期睾酮回升至正常值上限,中位回归时间11.2周。全部患者完成第1个周期的治疗,88.8%的患者完成2个周期的治疗,63.8%的患者完成3个周期的治疗,47.2%的患者完成4个周期的治疗,25.0%的患者完成5个周期的治疗,随访时间1～6.5年。生活质量评分显示,患者性趣、排尿症状和肠道症状等在间歇期得到显著改善(P<0.05)。结论间歇性内分泌方法是非根治性治疗局限性前列腺癌的有效手段。

多西他赛体外干预前列腺癌PC-3细胞转移能力的实验研究

目的:研究不同浓度多西他赛体外对人前列腺癌PC-3细胞侵袭力及MMP-2、MMP-9表达水平的影响。方法:在0.1血浆峰值浓度(peakplasma concentration,PPC)、1.0PPC、10.0PPC的多西他赛作用下,用Transwell小室对前列腺癌PC-3细胞的侵袭力与转移能力进行检测,并采用荧光定量RT-PCR方法检测转移相关水解蛋白酶MMP-2和MMP-9的变化。结果:经0.1PPC、1.0PPC和10.0PPC的多西他赛处理后,在1.0PPC和10.0PPC下,人前列腺癌PC-3细胞趋化、侵袭能力均下调,而0.1PPC浓度下,人前列腺癌PC-3细胞趋化能力变化不大,而侵袭能力明显降低。在各处理组PC-3细胞中,0.1PPC、1.0PPC和10.0PPC组的MMP-2mRNA的表达水平分别为0.40±0.12、0.36±0.16和0.26±0.09,MMP-9mRNA的表达水平分别为0.35±0.10、0.31±0.12和0.19±0.08,均显著低于两者相应的空白对照组,提示MMP-2和MMP-9转录水平明显降低。结论:多西他赛能够通过下调MMP-2和MMP-9基因的转录而抑制人前列腺癌PC-3细胞的侵袭力。

多西他赛治疗失败后的去势抵抗性前列腺癌及其骨转移治疗进展

去势抵抗性前列腺癌(CRPC)的标准治疗目前以多西他赛为化疗基础,但是对于多西他赛治疗失败后的CRPC尚缺乏有效的治疗手段。近年来,一些新的治疗药物已被批准用于临床治疗,还有一些药物则已经进入临床Ⅱ期或Ⅲ期试验,这些药物的作用机制包括稳定微管蛋白、抑制雄激素合成、阻断雄激素受体、骨靶向、调节免疫功能等。本文综述多西他赛治疗失败后的CRPC的治疗新选择。

机器人辅助腹腔镜根治性前列腺切除术结合扩大盆腔淋巴结清扫术治疗极高危局部进展期前列腺癌疗效分析

目的观察机器人辅助腹腔镜根治性前列腺切除术(RARP)结合扩大盆腔淋巴结清扫术(ePLND)治疗极高危局部进展期前列腺癌的安全性及有效性,探讨新辅助内分泌治疗(NHT)及新辅助化学治疗联合内分泌治疗(NCHT)对术后病理特征的影响。方法回顾性分析2015年10月至2019年3月我院收治的156例行RARP+ePLND治疗的极高危局部进展期前列腺癌患者的临床资料。记录并分析患者的初始前列腺特异抗原(PSA)、初始肿瘤TNM分期、Gleason评分、新辅助治疗方案、手术时间、术后血红蛋白下降幅度、围手术期并发症、住院时间及术后病理结果。结果156例患者年龄为(67.9±6.9)岁,初始PSA为56.5(8.4~629.0)ng/mL,Gleason评分≥8分者占63.5%(99/156),临床分期≥cT3者占95.5%(149/156),35.3%(55/156)的患者存在盆腔区域淋巴结转移;手术时间为(186.7±35.5)min,术后血红蛋白下降幅度为(18.8±9.9)g/L,住院时间为5(3~66)d;2例(1.3%)出现直肠损伤,3例(1.9%)在扩大淋巴结清扫过程中出现髂血管损伤;64.1%(100/156)的患者术后PSA下降至0.2 ng/mL以下,6.4%(10/156)的患者术后病理完全缓解(pT0),25.6%(40/156)的患者切缘阳性。51.3%(80/156)的患者出现病理降期,15.4%(24/156)的患者出现病理升期。35例确诊后未接受新辅助治疗而直接行RARP+ePLND(non-NT组),54例先接受4~6个周期NHT再行RARP+ePLND(NHT组),67例先接受4~6个周期NCHT再行RARP+ePLND(NCHT组)。NCHT组初始PSA和TNM分期高于NHT组和non-NT组(P均<0.01),但3组围手术期并发症发生率差异无统计学意义(P>0.05)。NHT组与NCHT组术后PSA达到根治水平以下的患者分别为72.2%(39/54)和82.1%(55/67),高于non-NT组的17.1%(6/35),3组间差异有统计学意义(P<0.01)。NHT组和NCHT组分别有57.4%(31/54)和68.7%(46/67)的患者出现病理降期,而non-NT组仅8.6%(3/35),3组间差异有统计学意义(P<0.01)。结论RARP+ePLND治疗极高危局部进展期前列腺癌安全有效。术前新辅助治疗并不增加RARP+ePLND围手术期并发症,且可提高手术根治率、改善术后病理结果。

前列腺电切术后偶发癌24例临床资料分析

目的:总结和分析前列腺电切术后前列腺偶发癌的临床资料。方法:对2815例前列腺增生患者,通过2年的随访,对其生存情况,前列腺特异性抗原(prostate specific antigen,PSA)进展情况和治疗方法进行总结与回顾。结果:本组患者前列腺偶发癌的发生率为0.85%(24/2815),其中T1a期9例,T1b期15例。2组的术前PSA分别是(2.61±1.02)μg/L和(2.89±0.92)μg/L,差异无统计学意义(P=0.12);术后病理Gleason评分分别是(4.52±0.49)和(7.15±1.22),差异有统计学意义(P=0.032)。T1a组9例患者中有4人选择等待观察,4人接受内分泌治疗,1人接受前列腺癌根治性手术;T1b组15例患者中,3人选择等待观察,11人接受内分泌治疗,1人接受前列腺癌根治性手术。随访2年,2组均未发现肿瘤相关性死亡。结论:T1b期肿瘤在Gleason评分上高于T1a期,无论采取何种治疗方法,2年内患者有着良好的生存率,无显著差异,长期随访的效果有待于进一步研究。偶发癌的再分期对指导治疗和预后有重要意义。

同期电切加电汽化治疗前列腺增生合并膀胱癌

目的探讨前列腺增生合并膀胱癌的治疗方法.方法对24例前列腺增生合并膀胱癌患者采用同期经尿道电切加电汽化术(TUEV),并进行术后随访.结果排尿症状均有明显改善,24例中有7例同时患有较严重的心血管疾患和严重的肺功能障碍,在术中及术后未出现任何并发症.随访6-42个月,4例复发,未发现前列腺窝有肿瘤种植转移.结论同期TUEV治疗前列腺增生并发膀胱癌效果满意,可减轻患者痛苦,减少治疗经费,缩短住院时间.

前列腺癌内分泌治疗前后的扩散成像研究:b值的影响

目的探讨内分泌治疗前后前列腺外周带癌区和非癌区的ADC值的变化情况,并比较不同b值时ADC值之间的差异。方法使用EPI扫描序列,对经手术病理或穿刺活检证实的14例前列腺癌和18例内分泌治疗6个月以上的前列腺癌患者行磁共振扩散加权检查,b值分别为300,500,800s/mm2。依病理结果,将前列腺六分区归类为癌区和非癌区,测量每个分区的ADC值,同时测量每位患者膀胱、闭孔内肌的ADC值。结果在三个不同的b值时,均获得了前列腺外周带癌区、非癌区、膀胱、闭孔内肌的ADC值。内分泌治疗后,不同b值癌区的ADC值均有升高,非癌区的ADC值(b值为500,300s/mm2)出现不同程度的降低,b值为800s/mm2时,ADC值变化不大;对照组和治疗组不同b值之间外周带癌区、非癌区、膀胱和闭孔内肌的ADC值间均有统计学差异。结论内分泌治疗后前列腺外周带癌区和非癌区的ADC值改变不同,不同b值所测得的前列腺外周带癌区、非癌区、膀胱和闭孔内肌的ADC值有差异,ADC值用于判断前列腺癌内分泌治疗效果是可行的。