前列腺癌骨转移的临床分析

目的探讨前列腺癌（PCa）骨转移的诊治方法。方法对1997～2004年收治的32例PCa骨转移的临床资料进行分析。结果19例PCa患者骨扫描发现骨转移14例，5例术后随访发现骨转移；13例先确诊骨转移瘤，继后查出原发灶。30例骨转移为多发，多累及脊柱与骨盆，2例单发者仅累及一侧骨盆。2例溶骨型改变用博宁治疗均部分缓解；28例多发成骨型骨转移者，9例^153Sm、19例^89Sr内照射治疗，总有效率分别为88．9％和89．5％，病灶客观反应有效率分别为21.4％和33．3％；2例单发成骨型转移者用^153Sm＋局部放疗，均完全缓解，3个月后病灶消失、缩小各1例。结论对PCa应早期和定期进行骨显像，PCa骨转移的诊治应综合病史、临床情况和影像学改变。

Clinical Analysis of Osseous Metastases in Prostate Cancer

Objective To study the diagnosis and treatment of osseous metastases in prostate cancer(PCa).Methods 32 cases of prostate cancer with osseous metastases treated during 1997~2004 were reviewed.Results The main means to diagnose osseous metastases in prostate cancer were needle biopsy of prostate and radionuclide bone scanning.Of the 19 cases with primary presentation of prostate cancer,osseous metastases were detected in 14 cases at the same time,5 cases during postoperative follow up examinations.The first site of detected lesions was bone metastases in another 13 cases.Spine and pelvis were frequently involved in 30 patients with multiple skeletal metastases,and pelvis in 2 solitary bone metastases.Metastatic bone pain was partly relieved in 2 patients with osteolytic metastases treated with bisphosphonates.Of 28 multiple osteoblastic metastases,the total relief rate of metastatic bone pain was 88.9% in 9 cases treated with ~(153)Sm-EDTMP and 89.8% in 19 cases treated with ~(89)SrCl_2.After 3 months,objective response rate of bony metastasis was 21.4% in patients treated with ~(153)Sm and 33.3% with ~(89)Sr.Bone pain disappeared in 2 cases with solitary osteoblastic metastases treated with ~(153)Sm and local radiotherapy.Conclusion Early and regular bone scanning is necessary for prostate cancer.Diagnosis and treatment for osseous metastases in prostate cancer should be based on clinical features and imaging findings.