Effect Analysis of Transurethral Resection of Prostate Combined with Endocrine Therapy for Advanced Prostate Cancer
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摘要:
目的 探讨经尿道前列腺电切术联合内分泌治疗对于中晚期前列腺癌患者的疗效与安全性。 方法 回顾性分析2014年1月至2017年12月期间收治87例伴有排尿困难症状的T3b、T4期晚期前列腺癌患者，分为2组。TURP组（n = 48），接受经尿道前列腺电切术治疗，术后再辅以规律内分泌治疗；对照组（n = 39），单纯予以规律内分泌治疗。对比分析2组治疗前后前列腺特异性抗原、最大尿流率、残余尿量、国际前列腺症状评分（IPSS评分）、5 a生存率等指标。 结果 TURP组术后3个月排尿困难症状缓解明显，各项指标较术前明显改善。PSA指标也较术前明显下降。在治疗3个月后，TURP组的IPSS、 Qmax、 RV、 PSA指标较对照组明显改善（P < 0.05）。2组患者在接受规范的治疗后PSA均值都逐渐下降，在刚开始治疗的12个月里，TURP组较对照组PSA均值下降更明显，但在治疗12个月后，2组的PSA均值对比差异无统计学意义（P = 0.056）。对2组患者随访5 a，对比分析发现2组的生存差异无统计学意义（P = 0.734）。 结论 TURP联合规律内分泌治疗能有效改善前列腺癌患者排尿困难症状，明显提升患者生活质量，同时并不会影响患者5 a生存率，是一种安全有效的治疗方式。 Abstract:Objective To evaluate the efficacy and safety of transurethral resection of Prostate（TURP） combined with endocrine therapy in patients with advanced prostate cancer. Methods A retrospective analysis was conducted on 87 cases of late-stage prostate cancer with dysuria admitted between January 2014 and December 2017. We divided them into 2 groups. TURP group （n = 48） received transurethral resection of prostate, followed by regular endocrine therapy. The control group （n = 39） was only given regular endocrine therapy. Comparative analysis of indicators such as prostate-specific antigen before and after treatment, maximum urinary flow rate, residual urine volume, International Prostate Symptom Score（IPSS）, and 5-year survival rate was performed between the two groups. Results Three months after TURP surgery, the symptoms of urinary difficulty significantly improved, and various indicators showed significant improvement compared to before the surgery. PSA levels also notably decreased compared to before the surgery. After 3 months of treatment, the TURP group showed significant improvements in IPSS, Qmax, RV, and PSA indicators compared to the control group（P < 0.05）. Both groups of patients experienced a gradual decrease in PSA levels after receiving standardized treatment. In the first 12 months of treatment, the PSA levels in the TURP group decreased more significantly compared to the control group, but after 12 months of treatment, the comparison difference was not statistically significant in the PSA levels between the two groups（P = 0.056）. A 5-year follow-up comparison of the two groups of patients revealed that there was no statistically significant difference in survival （P = 0.734）. Conclusion Transurethral resection of Prostate（TURP） combined with regular endocrine therapy can effectively improve the dysuria in prostate cancer patients, improve the quality of life of patients, and will not affect the five-year survival rate. TURP is a safe and effective treatment for advanced prostate cancer. -
表 1 2组治疗前基线资料对比（$\bar x \pm s$）
Table 1. Clinical parameters of the patients before treatment of the two groups（$\bar x \pm s$）
组别 IPSS
（分）Qmax
（mL/min）RV
（mL）PSA
（ng/mL）AGE
（岁）TURP组 20.2±2.3. 5.4±1.4 124.9±18.5 34.15±8.14 67.5±8.4 对照组 19.8±5.4 5.7±2.3 113.6±25.4 31.22±6.53 63.2±6.2 t 3.268 1.250 3.157 2.915 3.715 P 0.258 0.732 0.325 0.313 0.682 IPSS: international prostate symptom score，国际前列腺症状评分； Qmax：maximum urinary flow rate，最大尿流率；RV：residual urine volume，残余尿量；PSA:prostate-specific antigen，前列腺特异性抗原；AGE：年龄。 
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表 2 TURP组治疗前及术后3个月指标变化（$ \bar x \pm s $）
Table 2. Clinical parameters of the patients before and after 3-month treatment in TURP group（$\bar x \pm s $）
TURP组 IPSS
（分）Qmax
（mL/min）RV
（mL）PSA
（ng/mL）TURP术前 20.2±2.3 5.4±1.4 124.9±18.5 34.15±8.14 TURP术后 2.4±1.7 18.4±9.3 12.6±2.3 3.72±1.21 t 2.381 2.586 4.372 2.862 P 0.003* 0.011* 0.007* 0.006* *P < 0.05。
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表 3 TURP组和对照组治疗后3个月变化（$\bar x \pm s$）
Table 3. Clinical parameters of the patients after 3-month treatment between the two groups （$\bar x \pm s$）
组别 IPSS
（分）Qmax
（mL/min）RV
（mL）PSA
（ng/mL）TURP组 2.4±1.7 18.4±9.3 12.6±2.3 3.2±1.2 对照组 8±3.8 10.7±6.8 56.7±4.6 5.6±2.3 t 3.641 2.853 6.571 1.283 P 0.007* 0.003* 0.012* 0.025* *P < 0.05。
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表 4 TURP组和对照组治疗后PSA均值变化[$\bar x \pm s$，ng/mL]
Table 4. Changes of mean PSA after treatment in the two groups[$\bar x \pm s$，ng/mL]
组别 治疗前 1月 2月 3月 12月 24月 TURP组 34.15±8.14 13.72±6.31 10.24±5.31 3.23±1.21 2.32±1.40 1.58±0.31 对照组 31.22±6.53 28.45±1.92 24.61±5.43 5.64±2.32 2.52±1.31 1.46±0.52 t 8.543 5.431 3.591 7.216 8.623 7.615 P 0.077 0.003* 0.015* 0.009* 0.056 0.076 *P < 0.05。
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