| Background:In the world prostate cancer is one of the most common malignant tumor in male’sgenitourinary system. The statistics of United States in2010show the number of new prostatecancer patients is about220thousands, which is ranking first in the numbers of men sufferingfrom tumor. And the case fatality rate ranked second in all male’s cancers, only less than lungcancer.Radical prostatectomy is one of the most effective way to cure for localized prostate cancer,but according to the statistics,10years after local prostate cancer recurrence or distant metastasisincidence was27%~53%, after five years the patients who need hormonal therapy and radiationtherapy account for16%~35%. In addition to radical surgery，external radiation therapy andclose irradiation therapy are the selections of localized prostate cancer radical treatment.Particularly the latter can improve the local dose of prostate, and reduce the radiation dose of therectum and bladder, and the radiation side effects. It has significant advantage in these areas.At present, for advanced or distant metastasis, and lost the chance of radical surgery andradical radiotherapy of prostate cancer patients, the positive treatment of hormonal therapy hasbecome the preferred clinical choose. Hormonal therapy for prostate cancer has been appliedmore than60years, but because of its clear and curative effect affirmation role it is widely used.Hormonal therapy in combination with surgery and radiation therapy, also have significantcurative effect. Hormonal therapy is still the current main method in addition to the radicaltreatment of prostate cancer. For advanced prostate cancer patients, traditional palliative caresuch as pure castration or internal and external radiation therapy can relieve certain symptoms inthe short term, but it is hard to improve the recent curative effect and long-term survival ofpatients. So for these patients, it is priority to take the main comprehensive treatment of hormonal therapy. The purpose is to control the number of cancer, improve the body, improve thequality of life and prolong survival time. By far maximal androgen blockade is the most commonhormonal treatment, its way of castration therapy plus antiandrogen drug, can remove and blockthe role of adrenal gland and testis of all male hormone at the same time. For localized prostatecancer, application of MAB sustains the longer time of treatment, PSA and the recurrence ratewill keep the lower. Compared with pure castration MAB treatment can prolong the totalsurvival rate, and can lower the risk of death rate.A nine years study, taken by Jemal, etc, has show that the usage rate of hormonal therapy inpatients with prostate cancer has reach31%, the symptoms of more than80%patients ease, andtumor progression-free survival middle time reaches24months.Because hormonal therapy hasclear, curative effects, it is widely used. hormonal therapy in combination with surgery andradiation therapy, also can make significant treatment effect. But with the continuousdevelopment of hormonal therapy of prostate cancer, related side effects brought by hormonaltherapy also gradually cause the attention of clinicians.Maximal androgen blockade of endocrinetherapy can cause a series of metabolic changes such as obesity, hypertension, atherosclerosis,cardiovascular disease, type2diabetes and osteoporosis, etc. And in the various risk factors, thelargest danger factor is cardiovascular disease (CVD), which becomes the main cause ofincreasing the nonspecific mortality of prostate cancer. There is correlation with changes in thelevel of androgen and coagulopathy.Hormonal therapy can activate fibrinolytic enzyme activation inhibitors, reduceanticoagulant substances and, in turn, inhibit fibrinolysis, leading to higher incidence ofthromboembolic disease.After hormonal therapy for prostate cancer patient, the level of serumtestosterone/free testosterone drop, FPA, PAI-1increased significantly; Testosterone/freetestosterone and FPA, PAI–1has a linear negative correlation, the low testosterone/freetestosterone can activate thrombin, inhibit fibrinolysis. Through the promoting clottingabnormalities in the blood coagulation function, the body is in a state of high pour-point, andcause plaque hemorrhage and thrombosis, which bring about sclerosis of arterial congeeappearance.2011Chinese cardiovascular disease prevention guidelines suggest that thepopulation of cardiocerebrovascular events dangerous>10%the next10years take aspirin from75to100mg/d, as the primary prevention of cardiovascular disease.At present, clinical doctors has not reached a consensus on the need to prevent cardiovascular disease for prostate cancer patients after maximal androgen blockade hormonaltherapy, therefore, this study analyzed retrospectively the clinical data of prostate cancer patientsin our hospital to accept the maximal androgen blockade hormonal therapy and maximalandrogen blockade hormonal therapy in combination with aspirin. It can provide single center ofclinical research evidence in selecting of these two kinds of treatments.Objective:To compare the coagulation index of prostate cancer and PSA values of the maximalandrogen blockade hormonal therapy and maximal androgen blockade hormonal therapy incombination with aspirin for patients with prostate cancer.To compare the two groups of patientswith cardiovascular disease incidence. To discuss the safety of the use of aspirin in the prostatecancer after maximal androgen blockade hormonal therapy.Methods:A retrospective analysis was carried on for the Eighty-four patients with prostate cancer inour hospital from October2004to October2012. All of them were underwent the maximalandrogen blockade hormonal therapy (MAB). The follow-up time was2years.According to the different treatments，they were randomized into maximal androgenblockade hormonal therapy (MAB) group (43cases), maximal androgen blockade hormonaltherapy in combination with aspirin (MAB+ASPIRIN) group(41cases). Maximal androgenblockade hormonal therapy contains drug castration (goserelin sustained-release implant)+androgen deprivation (bicalutamide tablets). Patients in MAB group were given maximalandrogen blockade hormonal therapy, while Patients in MAB+ASPIRIN group were givenmaximal androgen blockade hormonal therapy and aspirin (100mg/d) for two years.Clinical information of patients were gathered, including age, TNM stage, Gleason score,Partial prothrombin time(PT)、 Activated partial thromboplastin time (APTT)、 Plateletaggregation(PAG)、 Prostate specific antigen(PSA)、 Testosterone(T) in pre-treatment andpost-treatment of6,12months.Monthly regular follow-up and telephone follow-up, patients withroutine blood, liver and kidney function, PSA, testosterone levels, myocardial enzyme spectrum,ECG examination, to observe the happening of gastrointestinal bleeding, severe bleedingtendency. Follow-up2years and observe the occurrence of cardiovascular disease, such ascoronary heart disease, myocardial infarction and sudden cardiac death.The concurrent time of cardiovascular disease,2-yr cardiovascular disease-free survival rate,cardiovascular disease-free survival time after treament and quality of life and complicationswere compared between the two group.Cardiovascular disease is defined as the occurance of cardiovascular disease symptoms including coronary heart disease, myocardial infarction and sudden cardiac death after treatment.And the results of myocardial enzyme spectrum, ECG examination prompt coronary heartdisease or myocardial infarction.Using SPSS13.0statistical analysis. Measurement data were expressed as (x±s). comparethe data of pre-treatment and post-treatment by paired-t test.Comparison between groups withtwo sample t test and chi-square test count data. Use Kaplan Meier-survival analysis methodand Log-Rank method for single factor analysis of survival rate test. P <0.05shows thatdifference was statistically significant.Results:1. Compared with pre-treatment, after6and12months of maximal androgen blockadehormonal therapy there were no significant changes in PT of both group contrast withpre-therapy(P＞0.05). In the MAB+ASPIRIN group APTT was prolonged and PAG wasdecreased significantly(P＜0.05), while in the MAB group APTT was shortened and PAG wasincreased significantly(P＜0.01). After treatment PSA、T In the MAB+ASPIRIN group was nodifference compared with it in the MAB group(P＞0.05).2. In two years2CVD cases(4.9%) happened in the MAB+ASPIRIN group which wasmarked lower than10cases(23.3%) of MAB group(P＜0.05).3.2-year cardiovascular disease-free survival rate of MAB group and MAB+ASPIRINgroup are76.7%(33/43) and95.1%(39/41) respectively.Therefore,2-year cardiovascular disease-free survival rate of MAB+ASPIRIN group is superior to that of MAB group (P＜0.05).Conclusions:1. Maximal androgen blockade hormonal therapy in prostate cancer can lead to theoccurrence of cardiovascular disease.2. Aspirin is safe and has efficacy in preventing cardiovascular disease in patients withprostate cancer after maximal androgen blockade hormonal therapy. |
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