The Effect Of Different Time NHT Combined With IMRT For Locally Advanced Prostate Cancer

Objective:The incidence of prostate cancer increased year by year.Most of them were late when they were treated and for most locally advanced prostate cancer were dealed with radiotherapy and endocrine.But there were no standard treatment options for the time of neoadjuvant hormornal therapy before the intesity modulated radiotherapy. The study of large long-term randomized controlled follow-up was lack.This study was to investigate ideal solution of neoadjuvant hormornal therapy of the locally advanced prostate cancer.Methods:60 patients diagnosed with locally advanced (T3.4N0M0) prostate cancer were treated with endocrine combined intensity modulated radiotherapy(IMRT).They were randomly divided into 3 groups of 20 cases.A group:neoadjuvant hormornal therapy(NHT) 2 weeks, B group:NHT 3 months, C group:NHT 6 months.NHT treatment with maximal androgen blockade (MAB).The methods were the surgical castration or medical castration (LHRHa) plus non-steroidal anti-androgen drugs (bicalutamide).Endocrine duration began with NHT until 12 months after the end of radiotherapy.The IMRT utilized helical CT scan and then drew the geometric model of prostates and normal tissue and to established a digital reconstruction.Hence the dose of external irradiation achieved higher intensive degree.The level of radiation dose was 2.0Gy every time,5 times every week.The average irradiation was total 78.6 Gy. The serum PSA, prostate volumes detected by transrectal ultrasound and Qmax were tested after NHT and every 3 months after IMRT.The changing of them were compared by statistical analysis.The differences of symptom improvement and local controlling among groups were observed.Then the reasonable NHT time was concluded.Results:The average PSA of different groups after NHT were 82.33ng/ml(14.02ng/ml-135.78ng/ml),85.23ng/ml(10.83ng/ml-167.22ng/ml) and 87.02ng/ml(12.51ng/ml- 157.92ng/ml) decreased to 24.53ng/ml(6.62ng/ml～55.86ng/ml),1.83ng/ml (0.05ng/ml～12.07ng/ml) and 0.35ng/ml(0.01ng/ml～2.01ng/ml) spectively.There was statistically significance(P<0.05) compared with untreatment.There was statistically significant(P<0.01) among groups.The prostate volume in B, C groups significantly reduced after NHT.The B group reduced 21% and the C group reduced 39%.There was statistically significant (P<0.05) between the two groups.The Qmax of B, C groups increased significantly (P<0.05) after treatment.There was statistically significance(P<0.01) between groups.There was statistically significance(P<0.01) of PSA,prostate volume and Qmax after endocrine combined with radiotherapy compared with untreatment.There was statistically significance(P<0.01) of PSA in A group compared with B,C groups 3 and 6 months after radiotherapy.The B and C group were lower than A group and there was no statistically significance(P>0.05) between the B and C groups.There was statistically significance(P<0.01) of PSA among groups 9 and 12 months after radiotherapy and the results was C<B<A group.The prostate volume reducing of B,C group was bigger than A group (P<0.01).There was no significant difference between B and C group (P>0.05).There was statistically significance(P<0.05) of Qmax in A group compared with B,C groups 3 months after radiotherapy.The B and C group were higher than A group and there was no statistically significance(P>0.05) between the B and C groups.There was statistically significance(P<0.01) among groups in other time and the results was C>B>A group.Conclusions:IMRT combines endocrine treatment is an ideal method for locally advanced prostate cancer.The NHT time before radiotherapy treatment lasts at least 3 months.