| BackgroundProstate cancer is one of the most common malignant tumor of older men,Its long-term living in the first incidence rate of male malignant tumor in the United States and Europe,the mortality of the second.the incidence of our country is much lower than the European and American countries. Qwing to changes in dietary habits, aging of the population and the improvement of the census means in recent years, China’s elderly men with prostate cancer incidence has a clearly upward trend.Because prostate cancer onset conceals, early lack of specific symptoms, Therefore, much of prostate cancer patients when begun treatment, the tumor had infiltrated the surrounding tissue or occured transfer of lymph nodes, bone, lung, so as to lose opportunity of radical surgery. In1941, Huggins and Hodges demonstrated that control of PCa growth rate by surgical castration and estrogen, and the first time confirmed that the removal androgen on the reaction of prostate cancer, Huggins won the Nobel Prize in Physiology or Medicine in1966.For patients with advanced prostate cancer, androgen deprivation therapy is the main treatment method, but it can not completely cure prostate cancer, it only delay the progression of prostate cancer,Because almost all patients will translate into hormone-independent prostate cancer (AIPC),so ADT belongs to palliative treatment, Therefore, how to slow prostate cancer from hormone dependent into androgen independent, domestic and abroad are studying this problem. Goldenberg et.al proposed intermittent androgen blockade treatment (IADT).IADT may provide the theoretical possibility of delaying hormone resistance,and has promise as a clinical strategy for minimizing these adverse events while delivering efficacy comparable to that of continuous ADT. Nonetheless, there still exists a need for documented Level1evidence demonstrating IADT’s clinical efficacy before it can be considered more than an experimental treatment option.In fact, most of the clinical trials with IADT have been performed as single-institution phase II studies. Should the evidence become more robust, then perhaps the concept of IADT may become more widely accepted. Many factors and potential outcomes justify further research into IADT. In particular, investigators have established that intermittent chemical castration may reduce the morbidity caused by long-term hormonal therapy and may ameliorate quality-of-life (QoL) issues associated with traditional ADT. But IADT is mainly applied to medical castration combined anti-androgen drugs, It may not fully applicable to patients of surgical castration,because patients of surgical castration after orchiectomy, androgen secretion by the testis was completely eliminated,so androgen can not restored to the level before treatment in interval treatment.Therefore,we can not be conventional IADT.Whether or not hasthe feasibility of completely continuous androgen deprivation therapy? Just like oral anti-androgen drugs after surgical castration,treatment after a period of time, disable anti-androgen drugs. When PSA increased or disease progress,oral anti-androgen drug therapy again.In theory, after surgery castration,androgens(about5%-10%) secreted by the adrenal zona reticularis cells,converted to dihydrotestosterone (DHT). continue to stimulate prostate cancer cell growth in prostate. Therefore, surgery castration combined with anti-androgen drugs carry out is not completely IHT, In theory is feasible. We expect to conduct a clinical study to examine the effect of advanced prostate cancer surgery surgical castration after intermittent associated with anti-androgen drug therapy. We expect to conduct a clinical study to examine the effect of surgical castration intermittent combined with anti-androgen drug therapy advanced prostate cancer.ObjectiveTo explore the clinical efficacy of surgical castration plus anti-androgen drugs in the treatment of advanced prostate cancer; expect to find a reliable clinical efficacy and economical treatment method;Object of studyFrom January2000to June2008,312advanced prostate cancer patients were selected from the Guangzhou General Hospital of Guangzhou Military Command, choose clinical data of complete, treatment law, follow-up complete object of study a total of91case;all patients were diagnosised prostate cancer by pathological physicians,conducted Gleason score.Combined with clinical examination data,By2or more experienced urologists joint diagnosed, belong toadvanced prostate cancer of lose radical surgery opportunities.Inclusion criteria:1.patients were diagnosised prostate cancer by pathological physicians,conducted Gleason score;2.Conduct lower abdominal B ultrasound, chest radiograph, lower abdomen MRI or CT,tumor invasion of adjacent tissues outside of the seminal vesicle, lymph node metastasis, bone metastasis or other organ metastasis.ensure tumor invasion of adjacent tissue outside of the seminal vesicle, lymph node metastasis, bone metastasis or other organ metastasis.Exclusion criteria:1. the cases not further conduct imaging examination, lack of clear clinical stages;2.after surgical castration or medical castration was not used anti-androgen drugs,stopped use anti-androgen drugs without doctor’s advice, during androgen deprivation therapy in stable condition, but the use of other treatment methods(e.g:radiotherapy, chemotherapy, HIFU and cryo-surgical ablation of the prostate,etc).MethodsIn this study, the clinical retrospective study, according to different treatment modalities,91patients were divided into two groups.experimental group,include51cases who underwent bilateral testicular resection and epididymis angioplasty under local anesthesia,postoperative first day intravenous antibiotics,switching to oral antibiotics, use2days. after surgical castration within one week accept bicalutamide(marketed as Casodex,50mg,oral,one time per day).40cases were as controlled group who underwent treatment of Luteinizing Hormone-Releasing Hormone analogue and bicalutamide.Bicalutamide was used one week before the initial injection LHRH-a, in order to stopping testosterone flare-up phenomenon. Two groups cases has no statistics differences in age,clinical stage,prostate specific antigen (PSA) level,Gleason score.regular examination serum PSA,and then stopped until the serum PSA was decreased below0.2ng/ml, which lasted three to six months. It was decided whether went on treatment according to the level of PSA. During the treatment and intermittence, serum testosterone level, PSA,liver and kidney function,routine blood, bone scan, pelvic MRI etc. all patients before treatment and6months after treatment and a treatment interval were assessed quality of life by using the EORTC QLQ-C30and QLQ-PR25quality of life score table.Follow-up all patients, the date of surgery or the first injection of LHRH-a as starting point of follow-up.determined progression-free survival time overall survival time.follow-up until June2011, the follow-up time from10months to99months, use SPSS13.0statistical analysis software for data analysis. ResultsThe two group patients all with clinical stage were stage IV, All of cases were sensitive to androgen deprivation treatment.3months after treatment, PSA levels showed varying degrees of decreased. bone pain, hematuria, and other clinical symptoms significantly improved. experimental group,include50cases,age72.82±6.17years old,control group, include50cases,age72.48±9.35years old.Two groups cases has no statistics differences in age (P=0.839),PSA (P=0.326) level,Gleason score (P=0.174),metastasis (P=0.873). two group patients progression-free survival time29.41±15.66months and28.03±11.39months,respectively.overall survival time of two group patients48.96±22.68months and42.40±17.17months respectively.Two groups patients has no statistics differences in progression-free survival time and overall survival time. The patients’overall survival time was not correlation with age (r=-0.004,P=0.967),has negative correlation with PSA level of before treatment (r=-0.265,P=0.01),has negative correlation with metastasis number (r=-0.548,P<0.001),has negative correlation with Gleason score (r=-0.419,P<0.001),has negative correlation with PSA level of3months after treatment (r=-0.236,P=0.02).The survival time arithmetic mean95%confidence interval of the experimental group patients was69.77to87.72months,the control group was53.19to87.72months.P vaule all>0.05use Log Rank test. Breslow test. Tarone-Ware test.The quality of life of patients has correlation with the patient’s age at the time of the treatment,<65-year-old patients underwent surgical castration had significantly effect cmpared with the preoperative., on the contrary,>85years old patients,underwent surgical castration, has not significantly effect on quality of life (P=0.127).Conlusions Surgical castration intermittent combined anti-androgen drugs as effective as medical castration combined with anti-androgen drugs in the treatment of advanced prostate cancer,at the same time is safe and effective. surgical castration combine anti-androgen drugs than medical castration combined with anti-androgen drugs greater degree saving the cost of treatment, with better economics benefits. Therefore, surgical castration intermittent combined anti-androgen drug is effective treatment approach for the therapy advanced prostate cancer, especially suitable for older or poverty-stricken areas poor patients. |
