| BACKGROUNDMalignant tumor has been the first killer of human health since 21 st Century,and the incidence of prostate cancer is atthe second place in all malignant tumors in the world.In our country,recent years,the incidence of prostate cancer was also significantly increased.It has become the highest incidence of cancer in the urinary system since2008,andhas become the world wide health problems for male.In China,with the development of screening prostate cancer specific antigen and prostate related surgery,the number of prostate cancer patients also showed a spurt of growth.But in small and medium-sized city and rural areas,PSA screening has not been so popular,so that most patients have sufferedan advanced stages of the disease,therefore,hormone therapy for prostate cancer is still our most useful clinical treatment.In 1941,Huggins found that the treatment of advanced prostate cancer patients with testicular resection or oral estrogen drugs as androgen deprivation therapy,has a very significant clinical effect.The purpose of endocrine therapy is to reduce the level of testosterone to the level of castration,which can inhibit the growth of prostate epithelial cells and inhibit the growth of tumor cells.However,in clinical practice,the application in the first treatment of androgen deprivation therapy is effective in nearly 90% patients,and almost all the patients in 2-3 years were inevitable progression to androgen independent prostate cancer,and the prognosis of these patients was poor,the median survival time was 18 months.How to prolong the time of endocrine therapy for prostate cancer,or how to prolong the time from androgen dependent to androgen independent,is the focus of clinical attention.Klotz in 1986 first proposed the use of intermittent androgen deprivation therapy method for the treatment of prostate cancer,in intermittent androgen suppression,the survival of tumor cells through the androgen supplement into normal differentiation pathway,thus restoring apoptosis ability,and can delayed hormone independent cell process.However,most clinical studies have reported that there is no obvious advantage compared with continuous endocrine therapy.The research on comparison of intermittent endocrine therapy and continuous endocrine therapy are the result of foreign genes based on the race,and prostate cancer with high specificity(race incidence of blacks and whites was significantly higher than that of yellow).Endocrine therapy may also have similar specificity.This study is a retrospective clinical study of endocrine therapy and intermittent hormonal therapy in genetic background based on intermittent hormonal therapy to clarify people specific,compared to continuous hormone therapy for the advantage of intermittent hormonal treatments for prostate cancer in China.CONTENTI PART: Prostate cancer follow-up database and the follow-up of patientsObjective: To establish a simple and practical database which can be used to manage the data of prostate cancer patients.Methods: 3 versions of prostate cancer clinical database were constructed.The first version of the database was based on the Win XP system,named PC-follow V1.0 based on Microsoft Access 2003 software.Second version of the database in the Win system,based on Microsoft Access 2010 software,named PC-follow V2.0.Third version of the database PC-follow V3.0,the development environment for Apache services +My SQL database +PHP language,the use of network database B/S architecture.The software covers the basic information of prostate cancer patients,diagnosis information,treatment information and follow-up information input,and can locate and export the information of the target population through the multi criteria query.It provides a guarantee for the effective preservation of patient information and standardization of follow-up.Results: PC-Follow has been included in our department from May 2000 to March 2017,all patients underwent radical prostatectomy,palliative resection,radical radiotherapy and endocrine therapy in patients with clinical data,a total of 3166 cases.Conclusion: The clinical database of prostate cancer is a convenient,fast,safe and easy-using database,it has a strong data management function,which disk space is small.It can be a certain effect to promote clinical research work for clinical diagnosis and treatment of the prostate cancer and prostate cancer from standardization.II PART: The construction of continuous endocrine therapy and follow-up of patients with prostate cancerObjective: To investigate the effect and prognosis of continuous endocrine therapy for advanced prostate cancer.Methods: A retrospective analysis of 127 patients with prostate cancer treated with continuous endocrine therapy.Results: 1.The age of the patients: there was no significant difference in the time of PSA progression and overall survival between the ages of above and below the age of 70 at the age of 70.2,The initial PSA value,initial PSA greater than 100ng/ml patients(15.5 months)and PSA less than 100ng/ml patients(24.09 months)there were significant differences in PSA in time,there was no significant difference in overall survival time.3 Gleason score: Divided into 6,3+4,4+3 level greater than 7,4 groups,PSA progressedtimes were 28 months,34.13 months,21 months and 11.5 months;the overall survival time was 51.33 months,68.56 months,53.94 months and 31 months.Conclusions: In the continuous endocrine therapy group,patients with low risk prostate disease were associated with longer PSA progression and overall survival compared to those with high risk.III PART: The construction of intermittent endocrine therapy system and follow-up of patients with prostate cancerObjective: To investigate the effect of intermittent endocrine therapy in the treatment of advanced prostate cancer.Methods: A total of 81 patients with prostate cancer treated with intermittent endocrine therapy were analyzed retrospectively.The patients were treated with maximal androgen deprivation for a period of 6 months.After PSA<0.2ng/ml withdrawal,monthly review of PSA,every 2 months' follow-up.After stopping the drug,divided into 4 groups,PSA<0-4ng/ml,PSA 4-10ng/ml,PSA 10-20ng/ml,PSA>20ng/ml start medication.Until the PSA<0.2ng/ml was discontinued again.Results: 1.The time of PSA progression was 44.92 months(intermittent group)and 19.4 months(duration group).The median survival time of the patients was months(intermittent group)and 36.5 months(continuous group).PSA progression time and overall survival time in the endocrine therapy group were significantly better than those in the continuous endocrine therapy group.2,In COX correlation coefficient,intermittent endocrine therapy group in patients with bone metastasis,Gleason score and the standard treatment are related;continuous endocrine therapy group and patients with bone metastasis,Gleason score and PSA in time are related.3,The age of patients,PSA,Gleason and standard treatment are analyzed: age at diagnosis: age greater than 70 and less than 70 years old at the time compared to PSA progression and overall survival time have no significant difference;The initial PSA value,initial PSA greater than 100ng/ml patients(33.37 months)and PSA less than 100ng/ml patients(60.38 months)there were significant differences in PSA in time,no significant difference in the overall survival time;Gleason score: divided into less than 6 points,3+4,4+3 level greater than 7,4 groups,PSA progression time were 57.8 months,55.75 months,40.75 months and 46.7 months;Intermittent medication standard: divided into 0-4ng/ml,4-10 ng/ml,10-20 ng/ml and >20ng/ml group,the time of 35.8 months,51.64 months,47.83 months and 34.75 months.4,the intermittent endocrine group and continuous endocrine group divided by bone metastasis and Gleason score were analyzed: hierarchical bone metastasis: without bone metastases in patients with intermittent treatment group and continuous treatment group compared to the PSA progression time was significantly prolonged,while there was no significant difference in overall survival time;bone metastasis in patients with intermittent treatment group with the continuous progressing of PSA in the treatment group compared with the time and survival time were significantly prolonged;Gleason score stratification: low Gleason score group(3+3,3+4),intermittent treatment group and continuous treatment group showed no significant difference in the time of PSA progression and overall survival time,high Gleason score group(4+3,4+4,4+5,5+4 5+5),intermittent treatment group PSA progression time and overall survival time were significantly prolonged.Conclusion: for patients with advanced prostate cancer,intermittent hormonal therapy group in the time of PSA progression and overall survival was significantly better than the continuous endocrine therapy group,predicts advanced prostate cancer patients in China and Europe and the United States compared to the existence of racial differences.IV PART: The study on the effect of testosterone monitoring during the endocrine therapy on the prognosis and curative effect of prostate cancerObjective: To investigate the effect of testosterone on endocrine therapy in prostate cancer patients.Methods: the clinical data of 127 patients with prostate cancer and 81 patients with intermittent endocrine therapy were analyzed retrospectively.Results: in the intermittent treatment group,the mortality of the patients was lower(mean 3.80ug/L)and survival group(mean 5.67ug/L).In the low testosterone level(<3ug/L): intermittent time to progression,OS was higher than that of continuous group(39.63/10.23 months,24.32/13.39 months).Conclusion: there is a negative correlation between the initial testosterone level and patients with high-risk prostate cancer.In the case of an initial low testosterone level,intermittent endocrine therapy is more effective.V PART: The influence of the economic factors and complications of prostate cancer endocrine therapy on the follow-up of patientsObjective: To investigate the influence of economy,complications and compliance on the follow-up of endocrine therapy for prostate cancer.Methods: The patients were followed up by clinic and telephone.Results: The rate of complication was 69.1% in patients with intermittent endocrine therapy,and the remission rate was about 91.1%.Conclusion: The formulation of the treatment plan should consider the economic,complications and compliance,and make a personalized choice according to the actual situation of the patients. |
PDF Full Text Request