Analysis Of The Efficacy Of Endocrine Combined With Palliative Prostatectomy In Patients With Advanced Prostate Cancer With Bladder Outlet Obstruction

Objective:By collecting the diagnosis and treatment data of patients with intermediate and advanced PCa with bladder outlet obstruction who were first diagnosed and treated in our hospital from January 2014 to December 2019,61 patients who met the criteria were selected.Use SPSS 21.0 to compare and analyze the data before and after treatment,and evaluate the curative effect.Hope to provide better guidance for patients with advanced PCa with bladder outlet obstruction.Methods:The clinical data of 61 patients with prostate cancer with dysuria or urinary retention were compiled from all PCa patients.Thirty-five patients who underwent palliative prostatectomy combined with endocrine therapy(hereinafter referred to as combination therapy)were included in the study group.Treatment method:pTURP under spinal anesthesia or general anesthesia,combined with ADT treatment after surgery.If the castration is selected,50 mg of bicalutamide tablets can be taken daily after surgery.Subcutaneous injection of 3.6 mg goserelin every 4 weeks.Patients who underwent bilateral testicular resection were given oral bicalutamide 50 mg once a day after resection.The remaining 26 patients without pTURP served as the control group and received ADT plus conventional medication.Use SPSS21.0 software to statistically analyze the general information and post-treatment data of the two groups of patients,and evaluate the efficacy and prognosis of the two groups of patients under different treatments,to provide better guidance for the treatment of patients with advanced PCa with clinical bladder outlet obstruction.Results:1.General information of patients:A total of 61 patients were included in the study,aged(75.3±8.1)years old,youngest 53 years old,maximum 89 years old;Gleason score(7.6±1.2)points,minimum 6 points,maximum 10 points;prostate volume(57.4±25.6)cm3,minimum 26.3cm3,maximum 172.0cm3;22 patients with moderate IPSS score(36.1%),39 patients with severe disease(63.9%);maximum urine flow rate(25.6±8.1)ml/s,minimum 4 ml/s,maximum 13 ml/s;median PSA15.2ng/ml,minimum 0.23 ng/ml,maximum 575 ng/ml;ISUP 2017 Gleason classification 1 group of 14 patients(22.9%),2 groups of 8 patients(13.1%),3 groups of 10 patients(16.4%),4 groups of 9 patients(14.8%),20 patients(32.8%)in 5groups;31 patients in T3 stage and 30 patients in T4 stage.2.Comparison between groups:The general information of the two groups of patients were compared before treatment,and there was no statistically significant difference between the patients'age,Gleason score,prostate volume,IPSS score,Qmax,and clinical stage(P>0.05);Comparing the data after 1 month and 3 months respectively after treatment,there were statistical differences in prostate volume,IPSS score and Qmax between the two groups(P<0.05),but there was no statistical significance in the comparison of PSA(P>0.05).3.Comparison within the group:By comparing the IPSS score,Qmax,PSA,and prostate volume before and after treatment in the two groups of patients,it was found that the patients after 1 and 3 months of treatment had significant curative effects and all the P value were less than 0.05,the difference was statistically significant.4.Comparison of survival time between the study group and the control group(32vs27 months)can benefit survival time,but after Log Rank test,there is no statistical difference in the overall survival time curve between the two groups of patients(?~2=1.131,P>0.05);in the comparison of the progression-free time curves,the progression-free time can be extended,but after Log Rank test analysis,the difference between the study group and the treatment group(27 vs 22 months)is also not statistically significant(?~2=1.268,P>0.05).Conclusions:1.Compared with the endocrine therapy alone,the patients treated with the combination have significant advantages in terms of IPSS score,Qmax and prostate volume after 1 to 3 months of treatment.2.In-group comparison of patients treated with combination therapy found that the quality of life of patients after treatment could be significantly improved in the short term,compared with patients before treatment,both in IPSS score,Qmax,prostate volume,and PSA were significantly improved,with differences.Statistical significance(P>0.05);3.Through the analysis of survival time and progression-free time curves,both the study group and the control group can prolong the survival time and disease progression time of the patients,but there is no significant difference between the two(P>0.05);4.By comparing the two different treatments,we found that both treatments can improve the patient's IPSS score,Qmax,PSA,and prostate volume,while prolonging the survival time and progression-free time of PCa patients.Improving the urination symptoms of patients also improves their quality of life,providing a strong basis for the clinical application of endocrine therapy combined with pTURP.