TURP结合抗雄激素干预治疗中晚期前列腺癌36例

目的:观察经尿道前列腺电切术(TURP)结合睾丸切除去势术及联合非甾体类抗雄激素治疗对前列腺癌伴尿道压迫梗阻患者的治疗作用.方法:中、晚期前列腺癌患者36例,经尿道前列腺电切术、睾丸切除去势术及联合氟他胺阻断雄激素治疗,主要观察手术前、后残余尿量(Ru)、最大尿流率(Qmax)、血清前列腺特异抗原(PSA)改变.结果:术后5 d拔除导尿管,排尿通畅.术后12个月,RU由术前的(130.0±15.2)mL降至(22.0±3.8)mL(P<0.01),Qmax由术前的(10.2±0.6)mL/s增至(21.2±2.2)mL/s(P<0.01).随访观察12～48月,血PSA降至2.8～18.6 ng/mL,平均10.7 ng/mL.术前发现6例骨转移经治疗后骨痛明显减轻,同位素骨扫描检查6例骨转移破坏均未见发展.结论:晚期前列腺癌压迫尿道致排尿困难时采用TURP可缓解膀胱出口梗阻症状,为抗雄激素治疗创造条件,睾丸切除联合口服氟他胺治疗可限制肿瘤的生长发展、巩固TURP的疗效.

Evaluation of the efficacy of TURP combined with antiandrogen therapy in patients with advanced prostatic cancer

Aim: To evaluate the therapeutic efficacy of transurethral resection of prostate (TURP)combined with antiandrogen therapy in patients with advanced prostatic cancer accompanied by urethral ob-struction. Methods: Therapy of thirty-six patients who received TURP combined with orchiectomy and oral Flutamide (total androgen blockade) in the Suzhou Municipal Hospital and the Second Affiliated Hospital of Suzhou University in China was reviewed. Residue urine (RU), maximum urine flow rate(Qmax) and serum prostate-specific antigen (PSA) level were examined before and after surgical operation, and clini-cal manifestation was also inveatigated. Results: The catheter was removed 5 days after operation. RU was decreased from (130.0±15.2) ml before surgical operation to (22.0±3.8) ml after operation (P<0.01 ), Qmax was increased from (10.2±0.6) mL/s to (21.2±2.2) mL/s (P<0.01 ). The patients were followed up for 12～48 months, the serum prostate-specific antigen (PSA) was reduced markedly,The bone pain in six patients with metastasis found before the operation relieved after treatment, Radionu-clide bone scan did not show bone metastasis development. Conclusion:TURP can relieve the bladder out-let obstruction symptoms in patients with advanced prostatic neoplasms, provide opportunity for the antian-drogen therapy. Antiandrogen therapy can inhibit the development of tumor, and consolidate the efficacy of TURP.TURP combined with antiandrogen therapy is an optimal therapeutic strategy for patients with pros-tate cancer accompanied by urethral obstruction.