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目的探讨应用间歇性内分泌治疗及放射性粒子植入联合应用治疗晚期前列腺癌的治疗效果。方法临床分期为T3期前列腺癌27例,间歇性内分泌治疗为药物去势联合抗雄激素治疗的全雄性激素阻断治疗,治疗时限选择为内照射前3个月加内照射后6个月,以后根据每月PSA的检测结果决定是否进行内分泌治疗,如果PSA持续升高,就再次启用内分泌治疗。内照射治疗是通过计算机三维治疗计划系统,经直肠超声引导将125I粒子均匀植入前列腺内。结果27例病人手术均顺利完成,未发生出血,感染等并发症。术后随访36～57个月,平均49个月。27例患者术后6个月后血清PSA均降至正常,前列腺体积明显缩小。其中3例患者术后26个月PSA持续上升,经内分泌治疗3～5个月后2例下降至正常范围,1例恶化发生骨转移,PSA无进展生存率96.3%。结论间歇性内分泌治疗与放射性粒子125I植入联合应用是近年来晚期前列腺癌综合治疗的有效手段。
Objective To explore the application of intermittent endocrine therapy combined with radioactive seed implantation in the treatment of advanced prostate cancer. Methods The clinical stage was T3 prostate cancer 27 cases, intermittent endocrine therapy for drug castration combined with anti-androgen therapy androgen blockade therapy, the treatment time is selected within 3 months before internal irradiation plus 6 months after irradiation, After the monthly PSA test results to decide whether to endocrine therapy, if PSA continued to rise, to re-enable endocrine therapy. Internal irradiation therapy is through the computer three-dimensional treatment planning system, guided by the rectal ultrasound 125I particles uniformly implanted in the prostate. Results The operation of 27 patients was successfully completed without bleeding, infection and other complications. Postoperative follow-up 36 to 57 months, an average of 49 months. Serum PSA decreased to normal after 27 months in 27 patients, and the volume of prostate decreased significantly. Three of the patients had persistent PSA at 26 months postoperatively, 2 cases dropped to the normal range after 3 to 5 months of endocrine therapy, and 1 case had bone metastasis with worsening. The progression-free survival rate of PSA was 96.3%. Conclusion The combination of intermittent endocrine therapy and radioactive 125I implantation is an effective method for the comprehensive treatment of advanced prostate cancer in recent years.