切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 152 -158. doi: 10.3877/cma.j.issn.1674-3253.2025.02.005

临床研究

序贯多学科会诊模式在前列腺癌全程管理中的应用
董振阳1, 瞿旻1, 王燕1, 张韻1, 高旭1,()   
  1. 1. 200433 上海,长海医院泌尿外科
  • 收稿日期:2025-01-07 出版日期:2025-04-01
  • 通信作者: 高旭
  • 基金资助:
    上海市申康三年行动计划(SHDC2024CRI033)

Application of sequential multi-disciplinary treatment in the full process management of prostate cancer

Zhenyang Dong1, Min Qu1, Yan Wang1, Yun Zhang1, Xu Gao1,()   

  1. 1. Department of Urology,Changhai Hospital,Shanghai 200433,China
  • Received:2025-01-07 Published:2025-04-01
  • Corresponding author: Xu Gao
引用本文:

董振阳, 瞿旻, 王燕, 张韻, 高旭. 序贯多学科会诊模式在前列腺癌全程管理中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 152-158.

Zhenyang Dong, Min Qu, Yan Wang, Yun Zhang, Xu Gao. Application of sequential multi-disciplinary treatment in the full process management of prostate cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(02): 152-158.

目的

本文报道一例局限前列腺癌随着疾病进展,逐渐发展为转移性去势抵抗性前列腺癌,近3 年经历三次序贯多学科诊疗(MDT)的病例,分享序贯MDT 在前列腺癌全程管理的应用经验。

方法

回顾1 例因“前列腺癌根治术后5 年生化复发予以内分泌治疗后PSA 升高”入上海长海医院前列腺癌多学科门诊就诊患者。整理其诊治经过,并总结诊治经验。

结果

该患者起病时为局限性前列腺癌,接受前列腺癌根治术后规律随访,术后长程的随访过程中,出现了生化复发、PSA进展、初始寡转移灶、多发转移灶等病程变化,期间经历三次序贯MDT,患者分别接受了辅助内分泌治疗,转移灶放疗、新型内分泌治疗、化疗等治疗方案。患者目前病情平稳。

结论

序贯MDT 的会诊模式在前列腺癌患者全程管理中发挥了重要作用,针对每一次疾病进展提出了较完整、有效的治疗方案。

Objective

This article reports a case of localized prostate cancer that progressed to metastatic castration - resistant prostate cancer.The patient experienced three sequential multi - disciplinary therapy (MDT) treatments in the past three years.The article shares the application experience of sequential MDT in prostate cancer management.

Methods

A patient with "5-year post-radical prostatectomy and subsequent endocrine therapy due to biochemical recurrence,resulting in PSA increase" was reviewed.The treatment process and experience were summarized.

Results

The patient initially had localized prostate cancer,underwent surgery and regular follow-up.During follow-up,biochemical recurrence,PSA progression,oligometastatic lesions and multiple metastases occurred.The patient underwent three sequential MDT treatments,receiving adjuvant endocrine therapy,radiotherapy for metastases,novel endocrine therapy and chemotherapy.The patient's condition is currently stable.

Conclusion

The sequential MDT consultation model plays a crucial role in prostate cancer management,providing comprehensive and effective treatment plans for each disease progression.

图1 前列腺癌患者主要诊疗事件及PSA 变化
图2 前列腺癌患者第1 次MDT 前68Ga-PSMA PET/CT 检查提示C6 转移灶 注:图a 为CT 平扫显像,b 为PET 显像,c 为PSMA 融合显像,d 为全身最大密度投影显像;箭头示C6 转移灶(2021 年2 月)
图3 前列腺癌患者第2 次MDT 前复查影像学提示T7 转移灶 注:a 图为ECT 骨扫描,a1,a2,a3 为平扫显像,a4,a5,a6 为核素融合显像;b 图为全身MRI,b1 为T2 显像,b2 为T1 显像,箭头示T7 转移灶(2021 年10 月)
图4 前列腺癌患者第3 次MDT 前68Ga-PSMA PET/CT 检查示出现新发病灶 注:a 为 L5 新发灶,a1~a3 为PET 显像,a4~a6 为CT 平扫,a7~a9 为PSMA 融合显像;b 为T7 新发灶,b1~b3 为PET 显像,b4~b6 为CT 平扫,b7~b9 为PSMA 融合显像;箭头示病灶(2023 年7 月)
[1]
Chen WQ,Zeng HM,Zheng RS,et al.Cancer incidence and mortality in China,2007[J].Chin J Cancer Res,2012,24(1): 1.DOI:10.1007/s11670-012-0001-6.
[2]
吴洪瀚,范青洪,瓦庆德.前列腺癌骨转移治疗研究进展[J].遵义医科大学学报,2024,47(4): 424-431.DOI: 10.14169/j.cnki.zunyixuebao.2024.0052.Wu HH,Fan QH,Wa QD.Progress in bone metastases treatment for prostate cancer[J].J Zunyi Med Univ,2024,47(4):424-431.DOI:10.14169/j.cnki.zunyixuebao.2024.0052.
[3]
Sekhoacha M,Riet K,Motloung P,et al.Prostate cancer review:genetics,diagnosis,treatment options,and alternative approaches[J].Molecules,2022,27(17): 5730.DOI: 10.3390/molecules27175730.
[4]
张俊彪,王志华.局限性前列腺癌的治疗新进展[J].现代泌尿生殖肿瘤杂志,2023,15(4): 193-196.DOI: 10.3870/j.issn.1674-4624.2023.04.001.Zhang JB,Wang ZH.Advances in the treatment of localized prostate cancer[J].J Mod Urol Reprod Oncol,2023,15(4): 193-196.DOI:10.3870/j.issn.1674-4624.2023.04.001.
[5]
王雨帆,邰胜,周骏,等.前列腺癌根治术中前列腺尖部及膀胱颈精准解剖与重建对尿控改善的影响[J].四川大学学报(医学版),2024,55(5): 1092-1098.DOI: 10.12182/20240960502.Wang YF,Tai S,Zhou J,et al.Impact of precise dissection and reconstruction of the prostatic apex and bladder neck on urinary continence improvement during radical prostatectomy[J].J Sichuan Univ (Med Sci Ed),2024,55(5): 1092-1098.DOI:10.12182/20240960502.
[6]
中国抗癌协会泌尿男生殖系肿瘤专业委员会,中国临床肿瘤学会前列腺癌专家委员会,中国肿瘤医院泌尿肿瘤协作组,等.泌尿男生殖系统肿瘤多学科团队诊治组织与实施规范中国专家共识(2020 年版)[J].中国癌症杂志,2020,30(4): 313-320.DOI:10.19401/j.cnki.1007-3639.2020.04.012.Chinese Anti-Cancer Association,Committee of Urological and Genitourinary Tumors,Chinese Society of Clinical Oncology,Prostate Cancer Expert Committee,Chinese Oncology Hospital Urological Tumor Collaborative Group,et al.China expert consensus on the organization and implementation of multidisciplinary team diagnosis and treatment of urogenital tumors (2020 edition)[J].China Oncol,2020,30(4): 313-320.DOI: 10.19401/j.cnki.1007-3639.2020.04.012.
[7]
中国抗癌协会泌尿男生殖系肿瘤专业委员会前列腺癌学组.前列腺癌骨转移多学科诊疗专家共识(2020 版)[J].肿瘤防治研究,2020,47(7): 479-486.DOI: 10.3971/j.issn.1000-8578.2020.20.2020.Prostate Cancer Group,Chinese Anticancer Association Genitourinary Oncology Committee.Expert consensus of multidisciplinary treatment on bone metastasis of prostate cancer (version 2020)[J].Cancer Res Prev Treat,2020,47(7): 479-486.DOI: 10.3971/j.issn.1000-8578.2020.20.2020.
[8]
许碧芳,汪紫娟,吴榕英.多学科诊疗护理干预模式对前列腺癌伴冠心病行前列腺癌根治术后的效果[J].心血管病防治知识,2022,12(11): 46-50.DOI: 10.3969/j.issn.1672-3015(x).2022.11.014.Xu Bifang,Wang Zijuan,Wu Rongying The effect of multidisciplinary diagnosis,treatment and nursing intervention model on prostate cancer with coronary heart disease after radical prostatectomy [J].Prevent Treat Cardiovasc Dis,2022,12(11):46-50.DOI:10.3969/j.issn.1672-3015(x).2022.11.014.
[9]
聂婷,史振峰,周萍,等.跨理论-多学科新型预康复策略改善机器人辅助前列腺癌根治术中青年患者早期转归和生活体验的研究[J].中国性科学,2023,32(3): 5-9.DOI: 10.3969/j.issn.1672-1993.2023.03.002.Nie T,Shi ZF,Zhou P,et al.Study on improvement effects of new inter-theorectical and multidisciplinary pre-rehabilitaion strategy on early outcome and life experience in young and middle-aged patients undergoing robot assisted radical prostatectomy[J].Chin J Hum Sex,2023,32(3): 5-9.DOI: 10.3969/j.issn.1672-1993.2023.03.002.
[10]
马丹丹,任洁,乔够梅.多学科团队诊疗模式在转移性去势抵抗性前列腺癌患者护理中的研究进展[J].华南国防医学杂志,2020,34(5): 366-368,封3.DOI: 10.13730/j.issn.1009-2595.2020.05.019.Ma DD,Ren J,Qiao GM.Research progress of multidisciplinary team diagnosis and treatment model in nursing care of patients with metastatic castration-resistant prostate cancer[J].Mil Med J South China,2020,34(5): 366-368,封3.DOI: 10.13730/j.issn.1009-2595.2020.05.019.
[11]
瞿旻,朱焱,塔娜,等.复杂前列腺癌综合诊疗的多学科团队协作全程管理一例[J].上海医学,2023,46(10): 687-692.DOI:10.19842/j.cnki.issn.0253-9934.2023.10.008.Qu M,Zhu Y,Tana,et al.A case of multidisciplinary teamwork in the management of complex prostate cancer[J].Shanghai Med J,2023,46(10):687-690.DOI:10.19842/j.cnki.issn.0253-9934.2023.10.008.
[12]
Ishemgulov R,Pavlov V,Izmailov A,et al.Stereotactic body radiation therapy using Cyber-Knife in the treatment of patients with localized prostate cancer[J].Eur Urol Suppl,2019,18(11): e3439.DOI: 10.1016/s1569-9056(19)34608-1.
[13]
Cheng Q,Butler W,Zhou Y,et al.Pre-existing castration-resistant prostate cancer-like cells in primary prostate cancer promote resistance to hormonal therapy[J].Eur Urol,2022,81(5): 446-455.DOI: 10.1016/j.eururo.2021.12.039.
[14]
Nikitas J,Rettig M,Shen J,et al.Systemic and tumor-directed therapy for oligorecurrent metastatic prostate cancer (SATURN):primary endpoint results from a phase 2 clinical trial[J].Eur Urol,2024,85(6): 517-520.DOI: 10.1016/j.eururo.2024.01.021.
[15]
Xiao-Xue Z ,Hong-Bin M ,Tie-Hua JYM.Actual over 3-year survival after stereotactic body radiation therapy in patients with unresectable intrahepatic cholangiocarcinoma[J].Clin Transl Oncol,2023,25(3): 731-738.DOI: 10.1007/s12094-022-02979-5.
[16]
Tilki D,van den Bergh RCN,Briers E,et al.EAU-EANM-ESTROESUR-ISUP-SIOG guidelines on prostate cancer.part II-2024 update: treatment of relapsing and metastatic prostate cancer[J].Eur Urol,2024,86(2): 164-182.DOI: 10.1016/j.eururo.2024.04.010.
[17]
Borkowetz A,Hölscher T.Metastasis-directed therapy in prostate cancer[J].Urologie,2024,63(3): 225-233.DOI: 10.1007/s00120-024-02281-y.
[18]
Assi T,Rassy E,Farhat F,et al.Docetaxel rechallenge in patients with metastatic prostate cancer: a comprehensive review[J].Oncol Res Treat,2020,43(6): 299-306.DOI: 10.1159/000506693.
[19]
Farolfi A,Calderoni L,Mattana F,et al.Current and emerging clinical applications of PSMA PET diagnostic imaging for prostate cancer[J].J Nucl Med,2021,62(5): 596-604.DOI: 10.2967/jnumed.120.257238.
[20]
Giri VN,Morgan TM,Morris DS,et al.Genetic testing in prostate cancer management: Considerations informing primary care[J].CA Cancer J Clin,2022,72(4): 360-371.DOI: 10.3322/caac.21720.
[21]
Achard V,Putora PM,Omlin A,et al.Metastatic prostate cancer:treatment options[J].Oncology,2022,100(1): 48-59.DOI:10.1159/000519861.
[22]
Padhani AR,Lecouvet FE,Tunariu N,et al.METastasis reporting and data system for prostate cancer: practical guidelines for acquisition,interpretation,and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate cancer[J].Eur Urol,2017,71(1): 81-92.DOI: 10.1016/j.eururo.2016.05.033.
[23]
Okudan B,Arıcan P,Seven B.Single-photon emission CT combined with spiral CT for early detection and localization of bone metastasis:a review[J].Curr Med Imaging,2020,16(5): 507-512.DOI: 10.2174/1573405615666181224143010.
[24]
Eiber M,Maurer T,Souvatzoglou M,et al.Evaluation of hybrid ⁶⁸Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy[J].J Nucl Med,2015,56(5): 668-674.DOI: 10.2967/jnumed.115.154153.
[25]
高旭.从PCWG3 共识的更新看去势抵抗性前列腺癌临床诊治的演变[J].中华泌尿外科杂志,2022,43(12): 884-888.DOI:10.3760/cma.j.cn112330-20220818-00469.Gao X.Evolution of clinical diagnosis and treatment of denervationresistant prostate cancer from the update of PCWG3 consensus[J].Chin J Urol,2022,43(12): 884-888.DOI: 10.3760/cma.j.cn112330-20220818-00469.
[26]
Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1): 8-10.DOI: 10.1200/jco.1995.13.1.8.
[27]
孙奕飞,张劲松,李宁,等.寡转移性前列腺癌诊疗的研究进展[J].中华泌尿外科杂志,2022,43(2): 152-155.DOI: 10.3760/cma.j.cn112330-20200418-00304.Sun YF,Zhang JS,Li N,et al.The progress in diagnosis and treatment of oligometastatic prostate cancer[J].Chin J Urol,2022,43(2): 152-155.DOI: 10.3760/cma.j.cn112330-20200418-00304.
[28]
高旭,王海峰,王燕,等.基于浏览器/服务器架构的前列腺癌数据库的构建和临床应用[J].中华泌尿外科杂志,2015,36(9): 694-698.DOI: 10.3760/cma.j.issn.1000-6702.2015.09.017.Gao X,Wang HF,Wang Y,et al.Construction and clinical application of prostate cancer database (PC-Follow) based on browser/server Schema[J].Chin J Urol,2015,36(9): 694-698.DOI: 10.3760/cma.j.issn.1000-6702.2015.09.017.
[29]
Pasoglou V,Larbi A,Collette L,et al.One-step TNM staging of high-risk prostate cancer using magnetic resonance imaging (MRI):toward an upfront simplified “all-in-one” imaging approach?[J].Prostate,2014,74(5): 469-477.DOI: 10.1002/pros.22764.
[1] 潘麒文, 何立儒. 前列腺癌放射治疗前沿进展荟萃[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 279-279.
[2] 杨健, 杨璐. 体液外泌体在前列腺癌诊断中的应用前景[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 146-151.
[3] 刘咏博, 郭佳. 外泌体在前列腺癌细胞免疫逃逸中的研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 140-145.
[4] 邱皓炜, 徐臻, 肖泽秀, 夏燕, 查高峰, 庞俊. 前列腺癌mRNA 疫苗研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 134-139.
[5] 李永红, 王骏, 肖恒军. 2025-NCCN前列腺癌诊治指南更新解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(02): 129-133.
[6] 罗添龙, 贺情情, 黄海. 泌尿功能障碍慢性病的长期综合管理和持久康复实践[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 21-26.
[7] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[8] 施一辉, 张平新, 朱勇, 杨德林. 机器人辅助前列腺根治术后切缘阳性的研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 633-637.
[9] 王功炜, 李书豪, 魏松, 吕博然, 胡成. 溶瘤病毒M1对不同前列腺癌细胞杀伤效果的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 626-632.
[10] 祝炜安, 林华慧, 吴建杰, 黄炯煅, 吴婷婷, 赖文杰. RDM1通过CDK4促进前列腺癌细胞进展的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 618-625.
[11] 李鑫钊, 张廷涛, 朱峰, 刘金山, 刘大闯. 血纤维蛋白原、D-二聚体及碱性磷酸酶诊断前列腺癌骨转移的价值分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 459-463.
[12] 杨勇军, 曾一鸣, 贺显雅, 卢强, 李远伟. ASA分级≥Ⅲ级患者局麻经会阴前列腺多模态影像融合穿刺的安全性和有效性[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 441-447.
[13] 胡思平, 熊性宇, 徐航, 杨璐. 衰老相关分泌表型因子在前列腺癌发生发展中的作用机制[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 425-434.
[14] 刘中文, 刘畅, 高洋, 刘东, 林世庆, 杨建华, 赵福义. 尿液microRNA-326与腹腔镜根治性膀胱切除术治疗膀胱癌患者预后的相关性研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 386-391.
[15] 李超, 刘羽阳, 曹建森, 苏振东, 封亚平. 脊髓损伤后心血管系统功能障碍[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(06): 321-324.
阅读次数
全文


摘要