| BackgroundIn most developed countries,prostate cancer is the most common malignant tumor and a leading cause of death in older men.In China,although the incidence rate of prostate cancer is not as high as that of developed countries such as Europe and the United States,It has been increasing constantly in recent years.Compared with other malignant tumors,the tumor cell of prostate cancer has an obvious character of bone seeking,and bone metastases account for about 70%of all distant metastases.Some patients have been found several tiny bone metastases at the time of initial diagnosis.The academic community defines this metastatic state with a small tumor load,an intermediate stage between localized disease and extensive metastasis as"oligometastasis".At present,endocrine therapy is still the main treatment for patients with bone metastases,but most patients will eventually be immune to endocrine therapy and progress into the castration-resistant prostate cancer.Many studies have shown that performing cytoreductive surgery on primary tumors such as kidney cancer,colon cancer in a metastatic stage can prolong the survival expectation of patients.But the clinical efficacy of cytoreductive radical prostatectomy for metastatic prostate cancer patients has not yet been proven.Therefore,it is necessary to conduct clinical research on the risk and benefit of cytoreductive radical prostatectomy for metastatic prostate cancer patients,especially those with bone oligometastasis.ObjectiveIn order to provide more treatment options for prostate cancer patients with bone oligometastasis,we probed into the efficacy of endocrine therapy combined with cytoreductive radical prostatectomy for those patients.MethodsThe clinical data of 49 prostate cancer patients with bone oligometastasis were analyzed retrospectively.According to treatment methods,patients were divided into endocrine therapy with cytoreductive radical prostatectomy group(n=21 cases)and endocrine therapy group(n=28 cases).In order to find differences in prognosis between two groups,we analyzing the data about serum PSA level,bone pain relief,new metastasis,progression and survival condition in the follow-up period.ResultsAll operations in the research group were completed successfully.The average operation time was(179.5±32.1)min,the amount of bleeding during the operation was(298.6±102.1)ml,the postoperative hospital stay was(10.3±2.3)days,and 1 patient got urinary leakage,1 patient got urinary tract infection,3 patients got wound infection.After symptomatic treatment,all patients recovered well,and no serious complications such as severe intraoperative bleeding,rectal injury,deep vein thrombosis and pulmonary embolism occurred.The minimum PSA level of research group was lower than that of control group,the difference was statistically significant(P<0.001).During the 1-year follow up period,the new metastasis rate of research group was significantly lower than that of control group(19.05%vs 46.43%),the difference was statistically significant(P<0.05).During the follow up period,the castration-resistant prostate cancer related progression rate(χ~2=4.400,P=0.036)and tumor progression rate(χ~2=5.004,P=0.025)in research group was a significantly lower than those in control group.Kaplan-Meier survival analysis showed that the prognosis of research group was better than that of control group.The differences in progress free survival(P<0.05)and castration-resistance related progress free survival(P<0.05)was statistically significant.ConclusionCompared with endocrine therapy alone,endocrine therapy with cytoreductive radical prostatectomy is safe and effective in prostate cancer patients with oligometastasis.Cytoreductive radical prostatectomy can significantly improve the quality of life and short-term prognosis of patients,but its long-term efficacy still needs to be tested by further clinical follow-up observation. |
PDF Full Text Request