The Clinical Research In The Treatment Of Advanced Prostate Cancer: Comparison Of Three Schemes Of Maximal Androger Blockage

Objectives: To evaluate the therapeutic effect of subcapsular orchiectomy combined albuginea cauterization of carbolic acid plus bicalutamide in the treatment of advanced prostate cancer, compared with total orchiectomy and medical castration combinated with bicalutamide.Methods: A total of 43 patients with advanced prostate cancer were randomized to 3 groups. GroupA(14patients) were treated with subcapsular orchiectomy combined albuginea cauterization of carbolic acid, groupB(15patients) underwent total orchiectomy, both of them were given bicalutamide after surgery; groupC(14patients) were maximal androgen blockaded with goserelin(an LHRH-analogue) and bicalutamide. Serum levels of prostatic specific antigen and testosterone were determined prior to castration and 1 week,1,3,6,9,12 months after castration. The maximum flow rate, Fugl-Meyer questionnaire and side effects were assessed after 6 months of treatment.Results:①The levels of testosterone research eunuchism at 1 week after surgery in group A, and there is no rise of them. At the sixth month after the operation ,the PSA levels reached the nadir,10(71%) of which are low than 1ng/ml.②The levels of testosterone research eunuchism at 1 week after surgery and then maitaining in group B. At the sixth month after the operation ,the PSA levels reached the nadir,12(80%) of which are low than 1ng/ml.③There is a transient surge of testosterone levels in groupC by the end of 1 week after LHRH-analogue therapy with statistical significance by contrast with the levels before medical castration(P=0.024,P<0.05). The testosterone levels of 13 patients research eunuchism by the end of the first month after drug therapy, The testosterone level of 1 patients higher than 50ng/dl. the PSA levels reached the nadir by the end of the sixth month after medical castration,11(78%)of which are low than 1ng/ml.④There is no statistical significance in testosterone or PSA levels between groupA and groupB.⑤The descending speed of testosterone of patients in groupA is faster than that in groupC, and has statistical significance by 1 week after treatment(P<0.01); so as the descending speed of PSA with statistical significance by 1 week after treatment (P=0.017,P<0.01),however there is no statistal significance in minimal PSA levels between two groups(P=0.846).Conclusions:①Castration by subcapsular orchiectomy combined with albuginea cauterization of carbolic acid has exact effect in the treatment of advanced prostate cancer, its procedure is simple, and easily mastered, it has minimal invasion, fewer postoperative complications, relative better exterior of scrotum, low side effect and hospital cost. Patients prefer accepting.②Medical castration needn't surgery, but has higher side effects, it may be suitable to those who have better economic foundation and slight clinical symptom.③The descending speed of testosterone and PSA levels of patients in surgery groups(groupA and groupB) is faster than that in groupC, the levels of testosterone in surgery groups research eunuchism at 1 week after treatment, which come in the 1 month after treatment in groupC. As some patient may can not research eunuchism, it is important to monitor the levels of testosterone.