| Objective:To explore the role and advantages of genetic testing in the diagnosis and treatment of advanced prostate cancer.Methods: We summarize through the form of case reports and consult relevant literature to elaborate and analyze the treatment methods of castration-resistant prostate cancer to guide the clinical.Results:Patients with prostate cancer(PCa)generally do not have any special clinical symptoms and signs at an early stage.Patients are often diagnosed by physical examination finding high level of PSA,digital prostate and rectal examination touch the nodules or metastatic bone pain,pathological fractures,etc.Ultrasound,CT,and MR examinations provide some help for its diagnosis,but pathological examinations are the gold standard for its diagnosis.The patient in this case was admitted to the hospital due to 1 month of PSA elevation and half a month of pain in the waist and abdomen.PSA showed: 52.03ng/ ml;urinary ultrasound showed prostate hyperplasia with calcification,solid prostate mass;prostate MR showed: abnormal signals on the right peripheral zone of the prostate and central lobe,abnormal signals of seminal vesicle glands,suggesting malignancy,consider invasion and seminal vesicle Gland;whole body bone imaging showed systemic bone abnormalities,and prostate biopsy was performed under ultrasound guidance,and prostate cancer was diagnosed pathologically.After the diagnosis,the patient received endocrine therapy and achieved satisfactory results.PSA dropped to normal levels within a short period of time.However,after 18 months of treatment,the patient's re-examination showed biochemical recurrence with back pain symptoms.We considered the diagnosis of castration-resistant prostate cancer based on the results of the examination,and given endocrine therapy combined with docetaxel chemotherapy and radionuclide therapy after adjusting the treatment regimen.After the above treatment,the PSA level of patients decreased rapidly to normal levels.Unfortunately,the patient did not follow the doctor's order to visit the hospital for chemotherapy on a regular basis.After 5 months,the patient's re-examination PSA showed an increase again,with obvious symptoms of bone pain.This patient's genetic test results show that the patient has detected gene mutations that are less effective in endocrine drugs such as flutamide,bicalutamide,abiraterone,enzalutamide;the patient may be more sensitive to platinum drugs;For docetaxel,platinum + etoposide toxicity may have low side effects,try platinum chemotherapy or olaparib targeted drugs,the effect may be better.However,according to the patient's own situation,guidelines and genetic test results,we continued to give the patient docetaxel treatment and achieved relatively satisfactory results again.A review of the PSA showed that: 10.56 ng / ml.Conclusions:Early prostate cancer usually has no special clinical symptoms and signs.Most of them are found during physical examination.MR examination provides some help for its diagnosis,but pathological examination is the gold standard for diagnosis.The initial efficacy of androgen deprivation therapy(ADT)is still acceptable,but as the disease progresses,androgen resistance will appear,and eventually develop into refractory castration-resistant prostate cancer.This genetic test is aimed at individualized diagnosis and treatment of prostate cancer,and provides a drug reference plan and prognostic evaluation.Patients are currently benefiting from adjustments to the treatment regimen,but their PSA levels are still high and require close follow-up. |
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