| Objective: Prostate cancer is one of the malignant tumor threatening the lives and health of countless men,and domestic male prostate cancer incidence increased year by year.Recent studies have found that the incidence of prostate cancer increased year by year in domestic and most people are diagnosis local advanced or metastatic prostate cancer when they diagnosis.Maximal Androgen Blockade(MAB)is the standard treatment.However,MAB treatment of patients are individual differences in efficacy,because the disease is heterogeneous in morphology and clinical behavior.Some patient rapid transit to castration resistant prostate cancer without effective treatment.Recently,three phase III trials investigating the benefit of upfront docetaxel chemotherapy for mHSPC have been reported,and two successfully showed a real benefit of upfront docetaxel chemotherapy in addition to standard ADT for mHSPC.Therefore,exploring the clinical factor to predict early and accurately the TTCRPC and guiding the individual progression time is very necessary.This study was retrospectively analyze the clinical factors of patients with TTCRPC after ADT treatment in our hospital,and to explore the key clinical indicators for predicting TTCRPC.Methods: We retrospectively analyzed in January 2006 to December 2015 in the second hospital affiliated to Dalian medical university in 121 cases of patients with prostate cancer through prostate puncture.All patients were treated with continuous MAB.PSA were performed monthly.According to the excluded standard include other tumors or the TURP or radical prostatectomy before MAB in 32 patients.Finally,89 patients were in group.According to TTCRPC interval is divided into two groups A and B,group A(TTCRPC ? 1 year)26 cases and group B(TTCRPC>1 year)63 cases.Age,BMI,Gleason scores,bone ECT,pre-treatment PSA,prostate volume and changes in PSA or testosterone after treatment after treatment were compared between the two groups.Results: The average age(73.1 ± 9.7)years,average BMI(24.0 ± 0.3)kg/m2,average PSA(260.1 ± 33.10)ng/ml,average prostate volume(51.2 ± 34.0)ml,median gleason score(range): 8(4~10),T stage(range): T3(2~4),median bone metastasis(range): 4(1~16)and 8 case of lung metastasis.All patients were treated with MAB treatment.our patients were followed up for 1 to 48 months,the average time of 20.6±13.0 month.66 patients developed CRPC during follow-up,of which 26(39.39%)patients developed CRPC within 1 year,12(18.2%)cases developed CRPC within 12~24month,28(42.2%)cases developed CRPC above 24 month.The clinical data for the treatment were: average PSA nadir(4.4 ± 13.2)ng / ml,average time to PSA nadir(7.4 ± 3.5)months.Time to PSA nadir was collected in patients treated with MAB.Time to PSA nadir was distributed between 4 and 12 months.Time to PSA nadir ? 6 months was 49 cases(55.6%).In group A,the number of bone lesions ?5 was 7 cases(29.2%),? 5 was 19 cases(73.1%),average PSA nadir(14.7 ± 21.4)ng/ml and average time to PSA nadir(4.9 ± 2.0)months;in B group the number of bone lesions ?5 was 36 cases(57.1%),? 5 was 27 cases(42.9%);average PSA nadir(0.2 ± 0.6)ng / ml,average time to PSA nadir(8.4 ± 3.6)months;We found the the number of bone lesions(P=0.09),PSA nadir(P=0.002)and the time of PSA nadir(P<0.001)were statistically significant difference by t's test and chi-square test.Log rank test was used to compare the differences TTCRPC in different subgroups.The results showed that the Gleason score(?6 vs.7 vs.?8)(P=0.01),T Stage(2 vs.3 vs.4)(P=0.033),the number of bone lesions(?5 vs.> 5)(P=0.02),PSA after 3 months treatment(? 1 ng / ml vs.> 1 ng / ml)(P=0.031),PSA nadir(? 0.2 ng / ml vs.> 0.2 ng / ml)(P<0.001),time to PSA nadir(? 6 months vs.>6)(P<0.001)was statistically different.Conclusion: 1.The TTCRPC were significant differences in patients with advanced metastatic prostate treated with maximal androgen blockade.2.Patients who have Gleason?7 score,the number of bone lesions > 5 months,T4 stage,PSA nadir> 0.1 ng / ml and time to PSA nadir ? 6 months are more likely to have CRPC in shorter time.3.Although the PSA nadir and time to PSA nadir were significantly correlated with the TTCRPC,but for most patients,PSA nadir occur after treatment for a longer period of time.Therefore,it is difficult to using PSA nadir predict TTCRPC in the early time. |
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