Precision Treatment Of Castration Resistant Prostate Cancer Based On Etiological Classification

Objective:The efficacy,safety and reliability of "4W1H" secondary biopsy principle were verified through the summary and analysis of the patients who underwent secondary biopsy for primary or metastatic prostate lesions in the Second Hospital of Tianjin Medical University,and the factors affecting the results of the second biopsy were analyzed.Immunohistochemical staining of tumor tissues is used to verify the multiple pathogenesis of castration-resistant prostate cancer and provide evidence for the molecular classification of etiology.Combining the principle of biopsy and the results of immunohistochemical staining,it provides individualized precision treatment for patients with castration-resistant prostate cancer.Methods:According to the "4W1H" secondary biopsy principle,biopsy of primary or metastatic prostate lesions in castration-resistant prostate cancer patients was performed.Pathological examination and immunohistochemical staining were performed on the acquired tumor tissues.Combined with the general conditions and pathological results of the patients,the factors affecting the needle biopsy were found out.According to the results of previous studies and immunohistochemical staining in our laboratory,patients with castration-resistant prostate cancer were classified by molecular typing based on pathology,and different types of patients used different treatment schemes to verify the feasibility of molecular typing.Finally,according to the different therapeutic effects of abiraterone on androgen receptor dependent patients,the immunohistochemistry of tumor tissue was conducted to summarize the sensitive molecular markers for the treatment of abiraterone.Results:1.The principle of "4W1H" secondary biopsy is safe and effective.When biopsy of metastatic lesions can be performed,biopsy of metastatic lesions is preferred,and biopsy of parenchymal organs or lymph nodes is selected as far as possible,followed by biopsy of bone metastatic lesions,and finally biopsy of primary prostate lesions.2.Combined with the results of immunohistochemical staining of the tissue,castration-resistant prostate cancer showed great heterogeneity and diverse pathogenesis,and when the tumor tissue was immunohistochemical stained,the negative rate of bone biopsy tissue was higher.3.Combined with immunohistochemical staining for etiological molecular typing,precision medicine has a good effect,but the overall prognosis of patients with neuroendocrine changes are poor.4.When only androgen receptor-related indicators are positively expressed in tumor tissues,treatment with abiraterone can not only significantly reduce the level of PSA,but also prolong the overall survival,PSA progression-free survival and radiologic progression-free survival.Conclusion:In this study,the principle of "4W1H" secondary biopsy was proposed.According to this principle,secondary biopsy can improve the acquisition efficiency,quantity and detection rate of metastatic tumor tissue in patients with metastatic castration-resistant prostate cancer.It provides an important basis for immunohistochemical staining of tumor tissue.Combined with the principle of biopsy and immunohistochemical staining,this study provided a guarantee for molecular typing of castration-resistant prostate cancer.After classification treatment,it can be preliminarily seen that the clinical outcome of patients with neuroendocrine changes are poor.However,AKR1C3 combined with FKBP5 as a marker can predict the treatment effect of abiraterone better.