【摘要】：目的探討晚期血清超高前列腺特異性抗原（prostate specific antigen，PSA）型前列腺癌患者的臨床特點(diǎn)和診療方法，提高對(duì)該類患者的診療水平。方法回顧性分析自2009年12月至2014年2月我科收治的28例首診時(shí)血清PSA水平超過500ng/ml的前列腺癌患者的臨床資料，分析該類患者的發(fā)病年齡、確診方法、病理結(jié)果、治療方案以及預(yù)后，總結(jié)該類患者的臨床特點(diǎn)，同時(shí)取同時(shí)期首診血清PSA低于500ng/ml的前列腺癌患者作為對(duì)照組，比較二者的發(fā)病年齡、病理結(jié)果、治療方案以及預(yù)后等有無差異。結(jié)果所有入組的28例患者在確診后均給予黃體生成素釋放激素類似物（LHRH-α）及雄激素拮抗劑等藥物行內(nèi)分泌治療，其中行“比卡魯胺片+醋酸戈舍瑞林緩釋植入劑”治療的患者有14例（50%），行“比卡魯胺片+注射用醋酸亮丙瑞林”治療的患者有14例（50%），患者應(yīng)用內(nèi)分泌藥物后其血清睪酮及PSA迅速下降，臨床癥狀緩解；用藥后有9例（32.1%）出現(xiàn)ED及性欲喪失癥狀，結(jié)合患者高齡等因素，未予以處理；7例（25%）患者出現(xiàn)面色潮紅，1個(gè)月后，該類副作用明顯減輕；2例(7.1%)出現(xiàn)胰島素抵抗，建議至內(nèi)分泌科診療，給予口服藥物治療，現(xiàn)患者血糖正常；1例（3.6%）患者出現(xiàn)男性乳房發(fā)育，3個(gè)月后癥狀消失。有12例患者同期行125I粒子植入治療,治療后10例患者疾病控制可，另外兩例疾病進(jìn)展，分別出現(xiàn)左腎和盆腔淋巴結(jié)轉(zhuǎn)移，后給予二者以多西他賽為基礎(chǔ)的化療方案治療；患者行125I治療后有5例出現(xiàn)輕至中度的下尿路癥狀（LUTS）及肛門會(huì)陰區(qū)不適，有3例出現(xiàn)暫時(shí)性的排便習(xí)慣改變或里急后重等直腸刺激癥狀，2例患者在術(shù)后前3天內(nèi)出現(xiàn)直腸出血癥狀，遠(yuǎn)期觀察未見患者出現(xiàn)尿道狹窄、直腸前列腺瘺等重大不良反應(yīng)。28例患者中有20例在確診時(shí)即已出現(xiàn)全身多發(fā)骨轉(zhuǎn)移現(xiàn)象，該類患者中7例患者行鍶（89）治療，另外13例患者行因卡膦酸二鈉治療。行89鍶治療的患者中只有1例出現(xiàn)原骨骼病灶增大和新發(fā)骨骼轉(zhuǎn)移灶，另外6例患者未發(fā)現(xiàn)有新發(fā)骨骼病變；給予因卡膦酸二鈉治療的13例患者中，有4例患者治療過程中出現(xiàn)新發(fā)骨骼病變，其他9例患者未出現(xiàn)骨骼病變，兩種方法相比對(duì)骨骼的保護(hù)作用沒有統(tǒng)計(jì)學(xué)意義（P＞0.05）。所有患者治療過程中有18例患者進(jìn)展為去勢(shì)抵抗前列腺癌（castrationresistant prostate cancer,CRPC），該類患者從一線內(nèi)分泌治療開始至進(jìn)展為CRPC的時(shí)間最長為21個(gè)月，最短為7個(gè)月，中位時(shí)間為13個(gè)月�；颊哌M(jìn)展為CRPC后在堅(jiān)持行內(nèi)分泌治療的同時(shí)，有3例患者對(duì)新發(fā)病灶行外放射治療后病情穩(wěn)定，9例患者在給予以多西他賽為基礎(chǔ)的行化療方案治療，化療后生存期最短的為2號(hào)患者，時(shí)間為2個(gè)月，最長的為17號(hào)患者，生存時(shí)間為9個(gè)月，化療過程中2例（7.1%）患者出現(xiàn)粒細(xì)胞減少性發(fā)熱，給予粒細(xì)胞集落刺激因子后，癥狀改善；1例（3.6%）患者化療起始階段出現(xiàn)腹瀉，對(duì)癥治療后癥狀消失；1例1例（3.6%）患者存在肢體麻木感，化療后第3~6天，癥狀消失；余未見其他不良反應(yīng)。另有6例出現(xiàn)新發(fā)骨骼病灶的CRPC患者采用“茵福+89鍶”治療后，，患者病情穩(wěn)定。本研究隨訪6~48個(gè)月，平均隨訪17.9個(gè)月，21.5%（6例）患者死于前列腺癌所引起的并發(fā)癥，7.0%（2例）患者死于惡病質(zhì)，1例（3.6%）患者因肝臟衰竭而死亡，死于心臟衰竭的患者1例（3.6%），1例（3.6%）患者因長期臥床死于墜積性肺炎，1例（3.6%）患者死于心肌梗塞，其余16例截至2014年2月仍在隨訪中，未見重大不良反應(yīng)。結(jié)論首診時(shí)血清高水平PSA前列腺癌患者臨床中較為少見，患者大多高齡，且較早出現(xiàn)骨骼等遠(yuǎn)處臟器轉(zhuǎn)移，預(yù)后差，需行內(nèi)分泌治療、放射治療、化學(xué)治療等綜合治療方法，而早期診斷、早期治療仍是影響預(yù)后及存活的重要因素。
[Abstract]:Objective To study the clinical features and diagnosis and treatment methods of patients with advanced prostate specific antigen ( PSA ) type prostate cancer , and to improve the diagnosis and treatment level of patients with prostate cancer .
There were 9 cases ( 32 . 1 % ) with ED and the symptoms of sexual desire loss after medication , combined with the age of the elderly and other factors , were not treated ;
7 ( 25 % ) patients had facial flushing , and the side effects were significantly reduced after 1 month .
In 2 cases ( 7.1 % ) , insulin resistance was found , and it was suggested to be treated with oral medication and the patient ' s blood glucose was normal .
One ( 3.6 % ) patients developed male breast development , symptoms disappeared after 3 months . 12 patients were treated with 125I seeds at the same time , 10 patients were treated with disease control after treatment . Two other diseases progressed , left kidney and pelvic lymph node metastasis respectively , and both were treated with docetaxel based chemotherapy regimen .
There were 5 cases with mild to moderate lower urinary tract symptoms ( LUTS ) and discomfort in the vaginal area after 125I treatment . There were 3 cases with rectal bleeding symptoms of temporary defecation habit change or internal emergency , and 2 cases had serious adverse reactions such as urethral stricture and rectal prostatic fistula . Among the 28 patients , only 1 case had original bone lesions and new bone metastasis .
Of the 13 patients treated with disodium ocephosphonate , there were 4 patients with new bone lesions in the course of treatment , and other 9 patients had no skeletal lesions , and there were no statistically significant effects on the protection of bone compared to the two methods ( P > 0.05 ) .
In 1 case ( 3.6 % ) , diarrhea occurred in the initial stage of chemotherapy , and the symptoms disappeared after treatment .
1 case ( 3.6 % ) had numbness of limbs , 3 - 6 days after chemotherapy , the symptoms disappeared ;
There were no other adverse reactions . 6 patients with new bone lesions were treated with " Yin Fu + 89 strontium " , and the patients died in the follow - up period of 6 to 48 months . The patients died of myocardial infarction due to liver failure . One patient died of cardiac failure ( 3.6 % ) . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . One patient died of cardiac failure . The prognosis was poor . Early diagnosis was still an important factor affecting the prognosis and survival .
【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.25

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