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目的探讨晚期前列腺癌手术去势后间歇性雄激素阻断治疗的临床疗效。方法选取2003年1月至2010年1月晚期前列腺癌患者24例(C1、C2、D1、D2期分别为2、6、10、6例),做睾丸去势手术后,采用间歇性内分泌治疗:氟他胺服用3～6个月,当前列腺特异性抗原(PSA)下降达到相对稳定水平(0.2～13μg/L)并维持2个月后停药,停药期间定期影像学检查及PSA监测,当PSA水平超过稳态水平2～3倍时进入下一周期氟他胺治疗,以此类推;抑那通在手术去势后18～24个月,当PSA大于稳态水平2～3倍时开始使用,1次/月,3次/疗程,以后每3年1疗程。结果 24例患者平均随访时间(38.7±14.3)月,22例生存,生存率91.7%;3例氟他胺耐药。停药间歇期>9个月,87.5%患者重复用药后仍能有效控制,重复用药后平均治疗时间(5.0±1.1)月。与单纯手术去势或持续内分泌药物治疗比较,间歇性内分泌治疗可明显延长肿瘤对雄激素依赖的时间。结论手术去势后联合间歇性内分泌治疗,可延缓患者向雄激素难治性前列腺癌的进展,是治疗晚期前列腺癌的有效方法。
Objective To investigate the clinical efficacy of intermittent androgen blockade in the treatment of advanced prostate cancer after castration. Methods Twenty-four patients with advanced prostate cancer from January 2003 to January 2010 were enrolled in this study (patients with 2, 6, 10, and 6 cases of C1, C2, D1 and D2 respectively). After the operation of testicular castration, intermittent endocrine therapy : When flutamide is administered for 3 to 6 months, the serum PSA is reduced to a relatively stable level (0.2 to 13 μg / L) and is discontinued after 2 months. Periodic imaging studies and PSA monitoring , When the PSA level exceeds the steady-state level of 2 to 3 times into the next cycle of flutamide treatment, and so on; inhibition of nasties after 18 to 24 months after castration, when the PSA is greater than the steady-state level of 2 to 3 times When to start using, once / month, 3 times / treatment, every 3 years after a course of treatment. Results The mean follow-up time (24 months) in 24 patients was (38.7 ± 14.3) months. Survival rate was 91.7% in 22 patients and 3 patients were resistant to flutamide. Intermittent discontinuation> 9 months, 87.5% of patients after repeated administration can still be effectively controlled, the average treatment time after repeated medication (5.0 ± 1.1) months. Compared with simple castration or continuous endocrine therapy, intermittent endocrine therapy can significantly prolong the androgen-dependent time of tumor. Conclusion Combined with intermittent endocrine therapy after castration can delay the progression of patients to androgen-refractory prostate cancer, which is an effective method for the treatment of advanced prostate cancer.