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目的:探讨长期内分泌治疗(ADT)老年前列腺癌患者停止ADT后性激素水平恢复情况。方法:回顾性分析2008年1月~2013年12月我院泌尿外科诊治的37例局限性浸润或转移前列腺癌患者的临床资料,所有患者均长期行ADT,在停止ADT治疗后进行长期随访观察并定期检测黄体生成素(LH)、睾酮(T)。结果:ADT停止后18个月,所有患者LH均超过去势水平(>1.1U/L),而仍有40.5%患者睾酮仍处于去势水平(<50ng/dl)。ADT撤停后30个月,尽管LH水平正常,32.4%患者睾酮水平仍<50ng/dl。多因素分析得出,ADT时间是唯一与睾酮恢复显著相关的变量。显著区分睾酮恢复>50ng/dl的ADT时间阈值为60个月。根据ADT时间(<60个月与≥60个月)建立分组,采用Kaplan-Meier曲线分析无睾酮恢复的生存状况。ADT少于60个月患者无睾酮恢复的平均生存时间是15.7个月(95%CI 6.6~22.1个月),而ADT超过60个月患者无睾酮恢复的平均生存时间是30.1个月(95%CI 18.9~39.6个月),Log-rank P=0.042。结论:年龄与ADT停止后睾酮恢复(>50ng/dl)没有显著相关性,老年前列腺癌患者进行ADT超过60个月,此后停药睾酮仍可很长时间内保持去势水平。
Objective: To investigate the long-term endocrine therapy (ADT) of elderly patients with prostate cancer to stop the recovery of sex hormone levels after ADT. Methods: The clinical data of 37 patients with localized invasive or metastatic prostate cancer who underwent diagnosis and treatment of urology in our hospital from January 2008 to December 2013 were retrospectively analyzed. All patients underwent long-term ADT and long-term follow-up after stopping ADT And regular detection of luteinizing hormone (LH), testosterone (T). RESULTS: At 18 months after ADT was stopped, all patients had LH overcast (> 1.1U / L), while 40.5% remained testosterone (<50ng / dl). Thirty months after ADT withdrawal, testosterone levels remained <50ng / dl in 32.4% of patients despite normal LH levels. Multivariate analysis showed that ADT time was the only variable significantly associated with testosterone recovery. ADT time threshold for significant discrimination of testosterone recovery> 50ng / dl was 60 months. Groups were grouped according to ADT time (<60 months and ≥60 months) and Kaplan-Meier curves were used to analyze survival without testosterone recovery. The mean survival time for testosterone-free recovery was 15.7 months (95% CI 6.6 to 22.1 months) in patients with ADT less than 60 months and 30.1 months (95% CI 18.9-39.6 months), Log-rank P = 0.042. CONCLUSIONS: There was no significant association between age and recovery of testosterone (> 50 ng / dl) after ADT was discontinued. ADT was more than 60 months in elderly patients with prostate cancer, and withdrawal of testosterone thereafter remained castrated for long periods of time.