| 摘要: |
| 目的：探讨 125I 放射性粒子植入联合最大限度雄激素阻断治疗高危前列腺癌的临床效果。方法：78 例高危前列腺癌患者，全身麻醉，截石位，经直肠超声勾画前列腺轮廓，计算机制定植入计划，经会阴 125I 放射性粒子依次植入，术后继续全雄激素阻断治疗 18 个月停止内分泌治疗，后每三月复查 PSA， PSA 连续 3 次上升≥ 2 ng/mL 或至原来底限的 2 倍，则重新开始内分泌治疗。结果：所有患者手术均顺利，植入粒子 41 ～ 94 粒，平均 69 粒。术后随访 18 ～ 54 个月，平均 35 月。术后 18 月内分泌治疗结束 56 例患者 PSA 降到 0.02 ng/mL 以下，18 例 PSA 未达到 0.02 ng/mL 以下，4 例患者出现 PSA 反弹；术后 27 月 1 例发生多发骨转移死亡；术后 39 月 3 例出现 PSA 反弹，再次全雄激素阻断内分泌治疗 3 个月 PSA 值下降到治疗时低值，目前随访中 53 例 PSA 在 0.02 ng/mL 以下，继续密切监测 PSA 及全身状况随诊观察。结论： 125I 粒子植入联合术后全雄激素阻断内分泌治疗是治疗高危前列腺癌的一种微创、可供高危前列腺癌选择的有效方法。 |
| 关键词: 高危前列腺癌 粒子植入 最大限度雄激素阻断 内分泌治疗 |
| DOI：10.3969/j.issn.1007-6948.2019.06.036 |
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| 基金项目:浙江省医学会临床科研资金项目资助（2012ZYC-A83）；浙江省金华市科技局社会发展重点项目资助（2017-03-16）；浙江省卫生厅科技计划资助项目 (2019-KY766) |
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| 125 I Seed Implantation Combined with Maximum Androgen Blockade in the Treatment of High Risk Prostate Cancer |
| ZHANG Chun-ting,XU Min,ZHU Sheng-sheng |
| Department of Urology, Jinhua People' s Hospital, Jinhua (321000), China |
| Abstract: |
| Objective To investigate the clinical effect of 125I radioactive seed implantation combined with maximum androgen blockade in the treatment of high-risk prostate cancer. Methods Seventy-eight patients with high risk prostate cancer were implanted the 125 I radioactive particles through the perineum under general anesthesia, and under lithotomy, to outline the prostate through transrectal ultrasound, to make the implantation plan by computer, then the endocrine therapy was stopped after 18 months of total androgen blockade, and PSA was tested every three months. PSA was increased by more than 2 ng / mL or two times original threshold for three times, then secretory therapy was resored. Results The operation of all patients was successful, 41—94 particles were implanted, with an average of 69 particles. The patients were followed up for 18—54 months, with an average of 35 months. After 18 months of endocrine therapy, PSA value of 56 patients decreased to less than 0.02 ng/mL, PSA vslue of 18 patients were less than 0.02 ng/mL, PSA value of four patients were rebound; one patient died of multiple bone metastases after 27 months of surgery; three patients had PSA rebound after 39 months of surgery, and they were treated use total androgen block endocrine therapy after 3 months, PSA was decreased to the low value at the time of treatment. At present, PSA value of 53 patients was less than 0.02 ng / mL during followed-up, and they were continued to be monitoring PSA and general condition. Conclusion 125 I seed implantation combined with total androgen blockade is a minimally invasive and effective method for the treatment of high-risk prostate cancer. |
| Key words: High risk prostate cancer particle implantation maximum androgen blockade endocrine therapy |
