摘要：探讨极高危前列腺癌(very high-risk prostate cancer,VHRPCa)采用新型内分泌药物新辅助治疗后给 予根治性前列腺切除术(radical prostatectomy,RP)的疗效。患者男，61岁，因“进行性排尿困难，夜尿增多4年，加重半年”就诊。总前列腺特异性抗原(total prostate specific antigen,tPSA)89.16 ng/ml。磁共振成 像示前列腺大小5.2 cm×4.6 cm×4.2 cm,右侧外周带前列腺癌累及中央带；直肠受侵，前列腺影像报告和数据 评分系统评分为5分；膀胱左后方及上方多发淋巴结增大。穿刺活检示前列腺癌，Gleason评分5+5=10分；骨扫描未见明显异常。采用新型内分泌药物阿帕他胺+地加瑞克新辅助治疗9个月后复查tPSA为0.05 ng/ml;磁共振成像见前列腺体积缩小。给予RP+盆腔淋巴结清扫，术中粘连明显，平面欠清晰。术后病理Gleason评分5+4=9 分，切缘和淋巴结均为阴性。术后维持原新辅助方案继续辅助治疗1年后，tPSA为0ng/ml;磁共振成像和发射 型计算机断层扫描成像未见异常，故改为单纯雄激素剥夺疗法(androgen deprivation therapy,ADT)继续维持 治疗，疗效满意。

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苏文惠，章志强，张宇兵，等.地加瑞克联合阿帕他胺用于极高危前列腺癌新辅助治疗1例报道[J]. 泌尿外科杂志（电子版）,2023,15(3):87-91. DOI:10.20020/j.CNKI.1674-7410.2023.03.17

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极高危前列腺癌(very high-risk prostate cancer, VHRPCa)易出现隐匿性转移和局部治疗(根治手术或放疗)后复发。前列腺癌新辅助治疗是指患者在接受根治性手术或放疗前使用抗雄激素药物、化疗等方式来提高病灶清除率并改善预后，为部分不适合手术的患者争取到手术机会。目前关于新型内分泌治疗(novel hormone therapy,NHT)药物用于前列腺癌新辅助治疗的临床研究初步获得了一定的效果。本文回顾性分析1例VHRPCa患者采用地加瑞克联合阿帕他胺新辅助内分泌治疗的病例，为患者赢得手术条件，术后取得满意疗效。

1 病历摘要

2 讨论

随着不断深入研究与发展肿瘤分子生物学及多种新型药物的研发与临床应用，通过基因/生物标记物筛选极高危局限性前列腺癌患者预判是否获益可能是未来的方向，以AR轴为主无其他靶向突变(SPOP, CHD1,ETS)采用强化抗雄激素治疗，与肿瘤抑制因子缺失(如PTEN,RB1,p53突变)有关采用化疗，或DNA损失反应改变采用多聚腺苷二磷酸核糖聚合酶抑制剂靶向治疗或免疫原性(MMRd/ CDK12)的改变采用程序性死亡受体1和(或)细胞程序性死亡-配体1为主的治疗等不同的情况，选择更加精准的合适的新辅助治疗方案，从而增加患者临床获益的可能性。

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