OS is over 5 years!Patients with widow metastatic prostate cancer

*For medical professionals for reading reference

Pickings for "miracles" of tumors!

At present, the diagnosis and treatment of metastatic prostate cancer has gradually become a hot issue in the urology field. In Asia, the incidence of prostate cancer is lower than that of European and American countries, and metastasis is the main factor that causes poor prognosis of prostate cancer. With the advancement of imaging diagnosis technology, the extension of the patient's survival of patients and the increase in the survival of tumor treatment levels, and the attention of the monitoring and follow -up of malignant tumors, the detection rate of "widow metastatic prostate cancer" has increased significantly in recent years.

In this issue of "Classification of Cases", Professor Dai Bo of the Cancer Hospital affiliated to Fudan University shared a case of long -living cases of metastatic prostate cancer patients. How can you obtain a total survival period (OS) for more than 5 years under the condition of relatively limited treatment selection (OS) under the condition of relatively limited treatment selection? Let's find out!

Basic information

A 64 -year -old male patient with pain on shoulders and back for 2 months. In February 2017, the MRI examination of the foreign hospital showed that the pathological fracture of the thoracic bodies, tumor metastasis to be eliminated, and the neck 3-7 intervertebral disk protruded with spinal stenosis. In February 2017, the tumor label examination of the Cancer Hospital Affiliated to Fudan University showed that: TPSA 77.840 ng/ml, the examination of the remaining tumor markers is within the normal range.

Patients have a history of benign tumor disease in thyroid, and have a history of hypertension for more than 15 years. Examination shows: ECOG score: 0-1 points, the abdomen is soft, no tenderness in the bladder area, the prostate III is large, the left leaf texture is harder, and the right leaf texture is tough.

In February 2017, PET-CT showed that the prostate left lobe was low-density, and no FDG metabolism was seen. It was recommended to puncture; T2 vertebral compressed fracture; the left side of the left side of the iliac bone, and the FDG metabolism increased.

In February 2017 PET-CT information

In February 2017, the MR examination of the Cancer Hospital affiliated to Fudan University showed that the abnormal signal cooker on the left side of the prostate tip; the surrounding uneven enhancement stove, combined with the medical history, conforming to the changes in malignant tumors. The tip of the right prostate and adjacent pelvic muscle uneven enhancement stove, and the abnormal signal nodules beside the left iliac blood vessels. The left side of the left side of the iliac bone is not uniformly enhanced, and there is a possibility of metastasis.

MR information of MR of the Cancer Hospital Affiliated to Fudan University in February 2017

In February 2017, the Cancer Hospital Affiliated to Fudan University was punctured: prostate glandular adenocarcinoma.

The characteristics of the disease:

Widow metastasis prostate cancer

First diagnosis of prostate gland cancer (CT2-3N0-1M1B)

Bone metastases: n = 2 (t2, iliac bone)

Obviously bone pain symptoms (PSI score: 6 points)

Measured prostate cancer,

What are the explorations of the academic circles?

For the treatment of prostate oligoma metastasis, the value of local lesions is attached to the value of local lesions. Related scholars in 2015 pointed out that the treatment of primary stoves and metastatic stoves on prostate cancer metastasis can reduce the new hair metastatic lesions.

In recent years, with the further deepening of the local treatment of prostate cancer, the discovery of tumors in the academic community not only depends on tumor cells, but also needs to be dependent on the micro -environment of tumor. Tumor lesions can release circulatory tumor cells, dendritic cells and cytokines, etc., to promote new diversions of tumor cells. Surgery and radiotherapy of the primary stove, while treating local lesions, the tumor microenvasor of the tumor rely on the tumor's remote metastases is eliminated.

A number of previous retrospective analysis showed that OS was extended for patients who metastasized prostate cancer prostate surgical treatment or radiotherapy comparison only received systematic treatment.

In addition, Horrad's research is a forward -looking random control study that divides patients with metastatic prostate cancer into two groups. One group of patients receive androgen deprivation therapy (ADT), and the other group of patients receive ADT + primary stove radiotherapy. The results showed that the PSA progress time in the ADT + primary stove radiotherapy group was prolonged, but OS did not be extended.

Horrad research ADT group and ADT + RT group PSA progress time (left) and OS (right)

StampeDe research is the largest clinical study of primary stove radiotherapy for patients with metastatic prostate cancer so far. This study was included in 2061 patients with first diagnosis metastatic prostate cancer, which was randomly divided into ADT group or ADT combined radiotherapy group at a ratio of 1: 1. The results of the study showed that the entire group of patient ADT combined radiotherapy could not extend the OS (P = 0.266) of patients; pre -set Asian group analysis found that among 819 patients with low metastatic loads, ADT combined radiotherapy can extend the patient's OS (HR (HR (HR (HR (HR (HR (HR = 0.68; 95%CI: 0.52-0.90, P = 0.007).

Surgical treatment based on systemic treatment,

Mentacle stove SBRT

The above -mentioned evidence -based medical evidence was obtained in the past two years. The time returned to 2017. At that time, there were no high -level evidence -based medical evidence to support metastatic prostate cancer patients for primary stove treatment. In 2016, Fudan University Affiliated Cancer Hospital registered a clinical study of widow metastatic prostate cancer (OMPCA-SHANGHAI). This research is an open, random, and controlling single-secrete therapy comparison local treatment combined with endocrine therapy against widow metastasis. Prosperous phase II clinical research on prostate cancer for a long time.

This study was incorporated into imaging examinations and found that there was a metastatic lesion. The metastases of the lesion were limited to lymph nodes or bones, and the number of metastatic stoves ≤5. The endocrine therapy began within 6 months. Essence The clinical effect observation observation of the root cause of the oligoplastment prostate cancer and the analysis of complications during perioperative surgery show that the risk of complications is not the restrictions of the root treatment of the prostate cancer at the root of the prostate cancer, and Surgery is safe, effective and feasible. In 2020, the European Cancer Internal Sciences (ESMO) Annual Conference announced the long -term follow -up results. After 28 months of follow -up, the mid -range imaging science of the control group and the treatment group was 50 months of VS NE.

OmpCa-SHANGHAI studies two groups of patient imaging PFS

The patient was diagnosed by the MDT of the Cancer Hospital of Fudan University to determine that the patient was a prostate cancer. Considering that the patient was relatively young, the basic disease (hypertension) was well controlled. Clinical Study of OmpCa, a clinical study of the center of Fudan University Affiliated Cancer Hospital. The first three months of endocrine therapy (bibaramide+goshelin) combined with bisporama therapy to evaluate the implementation of tumor reduction prostate resection surgery.

In June 2017, MR examination showed that the range of prostate lesions was reduced compared to the front, and the left seminal vesicles gland bleeding. The left -sulfeine side cystic nodules are narrowed before, and there is a possibility of transfer of the left iliac bone. On June 25, 2017, the root treatment of the prostate cancer was opened. Postoperative pathological shows: prostate glandular adenocarcinoma, cancer cell plasma dyeing, adenal blister collapse, and significant changes after endocrine therapy.

June 2017 MR Imaging Information

In January 2018, three -dimensional orientation radiotherapy (SBRT) was performed for metastatic lesions. The second thoracic spine and the left sarbone, a straight accelerator radiotherapy, a single dose of 4000cgy. In June 2018, MR examination showed that after prostate cancer surgery, there was no obvious recurrence signs at present, and the left side of the left side of the iliac bone abnormal signal was enhanced, and the scope was roughly the same. Follow -up until September 2019, the patient's PSA has a rise.

In September 2019, MR examination showed that after prostate cancer surgery, there was no obvious recurrence signs at present, and the left side of the left side of the iliac bone abnormal signal was enhanced, and the scope was roughly the same. ECT shows: T2 does not see abnormal radioactive distribution; the radioactive distribution of lesions at the original left sacroiliac joints tends to be normal. The patient's PSA continued to rise, considering the metastatic resistance resistance prostate cancer (MCRPC), giving discontinued bibaramide, and adding Aibi Dragon for treatment. From September 2019 to December 2021, the patients were stable, and the PSA maintained between 0.01-0.1 and maintained ADT+Abbit Dragon treatment during the period. In September 2021, PSMA testing: After prostate cancer, after bone metastatic stove radiotherapy, T2 and left iliated bone metastases have become normal.

Finally, Professor Dai Bo made a wonderful summary of this case: Win -to -metastory prostate cancer is in the "intermediate" stage of clinical limitations and extensive metastasis. If such patients are treated with systemic treatment according to traditional therapy, they are prone to drug resistance and disease. progress. Nowadays, the treatment concept of widow metastatic prostate cancer has undergone fundamental changes. Patients can achieve stability of the disease on the basis of systematic treatment. Essence At present, more and more evidence -based medical evidence supports radiotherapy for metastases. So far, patients have been OS for more than 5 years.

The first release of this article: the medical world tumor channel

Author of this article: Dali

Editor in charge: Sweet

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