关键词: 前列腺癌, 随访, 生存, 进展

Abstract: Background and purpose: In recent years, the incidence of prostate cancer has increased year by year, the screening of prostate cancer is still not comprehensive, and the domestic prostate cancer database is also relatively scarce. The purpose of this study was to analyze baseline characteristics, treatment and survival of prostate cancer patients from the Fourth Hospital of Hebei Medical University, in order to provide reference for the diagnosis and treatment of prostate cancer in Hebei and its surrounding areas. Methods: The information of 857 patients with prostate cancer treated in the Department of Urology, the Fourth Hospital of Hebei Medical University from Jan. 2008 to Dec. 2018 were analyzed retrospectively. Patients with non-metastatic prostate cancer (M ₀ ) or distant metastatic prostate cancer (M ₁ ) were analyzed for baseline characteristics, treatment and survival at the time of first visit. Kaplan-Meier method was used to draw survival curves, and log-rank test was used to compare survival rates between the two groups. Results: A total of 857 patients were included in the baseline statistics. Among those, 797 cases had prostate-specific antigen (PSA) record, and 689 cases had Gleason score record. The median age of all patients was 71 years. Among 412 M ₀ patients and 445 M ₁ patients, 11.1% (44/397) and 57.3% (229/400) patients had a PSA of ≥100 ng/mL respectively, as well as 46.9% (166/354) and 63.9% (214/335) patients had a Gleason score of ≥8 respectively. A total of 606 patients were included in the follow-up analysis, 395 patients survived, and 211 patients died. A total of 182 patients died of tumor progression. The 5-year survival rates of M ₀ and M ₁ patients were 63.2% (76/120) and 41.3% (102/247) respectively. The median overall survival time of M ₀ and M ₁ patients were 85 months and 47 months (P<0.01) respectively. Additionally, in all M ₁ patients and high-risk metastatic hormone-sensitive prostate cancer (mHSPC) patients using traditional endocrine therapy (androgen deprivation therapy, ADT or combined androgen blockade, CAB), the median time to PSA progression (TTPP) was 18 months and 17 months respectively. The median TTPP of M ₀ patients treated with endocrine therapy was 25 months. For 12 patients with castrate-resistant prostate cancer and no detectable clinical metastasis using imaging examinations (non-metastatic castrate-resistant prostate cancer, NM-CRPC), the median metastasis-free survival (MFS) time was only 16 months. Conclusion: Patients with prostate cancer had advanced age, elevated PSA level and high Gleason score. Most of the patients had metastasis at the time of treatment. The 5-year survival rate was low. Therefore, the prostate cancer screening should be valued and strengthened. M 1 patients treated with endocrine therapy had a short time to progress to metastatic castrate-resistant prostate cancer (mCRPC). Moreover, after M ₀ patients treated with endocrine therapy progressed to NM- CRPC, the time for progression to mCRPC or death was also very short. In the future, M ₁ and NM-CRPC patients will need more aggressive treatments in order to delay the progression to the mCRPC.

Key words: Prostate cancer, Follow-up, Survival, Progression