Clinical Characteristics, Diagnosis And Treatment Of Prostate Cancer With Super-high Level Serum Of PSA

Objective This paper is intended to analyze the clinical features of prostate cancer with super-highlevel serum PSA, to explore the methods and effects of its diagnosis and treatment, and to improve thediagnosis and treatment level of this kind of patients. Methods Clinical data of28cases of this type whichwe treated from December of2009to February of2014were collected and their age, diagnostic methods,pathology, treatment and prognosis were all retrospectively analyzed. And we analysised the differences ofof age, pathology, treatment and prognosis between those patients which PSA level were below500ng/mland them. Results All the28patients were treated with hormonal therapy (HT) that contained LHRH-αand antiandrogen drugs.14(50%) of these28patients were given bicalutamide and goserelin, and the other14(50%) patients were given bicalutamide and leuprorelin. A few months later after HT, all the patients’serum of testosterone and PSA both went down quickly, and their symptoms disappeared.9cases（32.1%）of these people felt libido and ED because of these hormonal medicines, considering their old age, wedidn’t give them any drug-treatment during the therapy;7cases（25%）felt flush on their skin and face andthis kind of complication vanished one month later;A special complication--Insulin resistance shows up on2cases, and we advised them to go to the endocrinology department for formal treatment, now their bloodglucose at the normal level. Gynecomastia shows up on one person,but this kind of complication vanishedone month later.12of them received125I seeds implantation brachytherapy after the diagnosis was madeand10patients’ disease controlled very well after this kind of treatment, and the other two cases diseaseprogressed, their left kidney and pelvic lymph nodes were invaded respectively and docetaxel were givenfor chemotherapy treatment.5cases of these patients suffered from the complications of mild to moderatelower urinary tract symptoms (LUTS) and the anus perineal discomfort after the125I seeds implanted; therewere3cases of temporary changes in bowel habit or rectum stimulus symptoms such as tenesmus,2casesof patients in postoperative rectal bleeding symptoms within3days, and in our follow-up days we did notsee any patients with urethral stricture, rectum fistula of prostate and other major adverse reactions.20cases of the28prostate cancer patients were appeared with bone metastatic in the early stage ofdiagnosis,and13patients suffered from pain of bone metastasis were treated with incadronate, the other7 patients were treated with strontium-89(89Sr).2cases of the patients that given89-strontium treatmentappear in the original bone lesion enlarged and new bone metastases, the other5patients were not found tohave any new bone lesions. Given by incadronate treatment of13cases,5cases with new bone lesionsappeared in the process of treatment, the other8patients without bone lesions. Of all the patients,18caseswere turned into castration resistant prostate cancer (CRPC) after several months of hormonal therapy, thelongest time of these patients from hormonal therapy to CRPC was21months, the shortest was sevenmonths, the median time was13months.3cases of them were in a stable condition after external beamradiotherapy,9cases were treated with combined chemotherapy of docetaxel and prednisone but6of themdied sevel months later. The shortest survival time after Chemotherapy was case2for2months, thelongest, case17survival time was nine months. Granulocyte reduce fever was appeared in2patients duringthe chemotherapy, after giving the granulocyte colony stimulating factor, symptom improvement; At thebeginning of occurrence chemotherapy, one patient suffered from diarrhoea, but this symptoms disappearedafter symptomatic treatment was given;1case (3.6%) of patients with limb numbness every time ofchemotherapy, but after3~6days later this symptoms disappear; the others show no adverse reactions.Patients were follow-up for6-48months with a mean of17.9months,21.5%(6cases) patients died ofcomplications caused by prostate cancer,7.0%(2cases) patients died of cachexia,1case (3.6%) patientsdie from liver failure,1case (3.6%) died of heart failure,1case (3.6%) patients in bed for a long time dieof hypostatic pneumonia,1case (3.6%) died of myocardial infarction,and on different in the other16patients. Conclusion Those prostate cancer patients with super-high level serum PSA at the first treatmentare very rare,most of them are at their old age and suffered with bone metastasis at the early stage ofdisease,and with poor prognosis. Comprehensive treatments should be taken when we treated thesepatients,such as hormonal therapy, radiotherapy, chemotherapy and so on. But the early diagnosis andearly treatment are still the important factors influencing the prognosis and survival.