Gleave M E, Bruchovsky N, Moore M J, Venner P
University of British Columbia, Vancouver General Hospital.
CMAJ. 1999 Jan 26;160(2):225-32.
A 70-year-old man is referred to a urologist for recommendations on the management of metastatic prostate cancer. His cancer was diagnosed 5 years ago, and he underwent radical prostatectomy at that time. The tumour was confined to the prostate gland (Gleason score 7), and during surgery the lymph nodes were assessed as being clear of cancer. Before the surgery, the patient's prostate-specific antigen (PSA) level had been 8 ng/mL. After the prostatectomy, PSA was at first undetectable, but recently the PSA level rose to 2 ng/mL and then, at the most recent test, to 16 ng/mL. A bone scan was ordered to investigate back discomfort, which has been persistent but easily controlled with acetaminophen. Unfortunately, the bone scan shows several sites of metastatic disease. The man's medical history includes type 2 diabetes, which has developed during the past 3 years and which is controlled by diet, as well as asymptomatic hypertension, which is managed by means of a thiazide diuretic. The patient asks what treatments are available, what impact they are likely to have on his disease and what risks are associated with the therapies.
一名70岁男性因转移性前列腺癌的治疗建议被转诊至泌尿科医生处。他的癌症于5年前确诊，当时接受了根治性前列腺切除术。肿瘤局限于前列腺（ Gleason评分7分），手术期间评估淋巴结无癌细胞转移。手术前，患者的前列腺特异性抗原（PSA）水平为8 ng/mL。前列腺切除术后，PSA起初检测不到，但最近PSA水平升至2 ng/mL，在最近一次检测时又升至16 ng/mL。因持续存在背部不适但对乙酰氨基酚易于控制，遂进行骨扫描以排查病因。不幸的是，骨扫描显示有多处转移病灶。该男子的病史包括过去3年中患上的2型糖尿病，通过饮食控制，以及无症状高血压，通过噻嗪类利尿剂进行治疗。患者询问有哪些可用的治疗方法，这些治疗方法可能对他的疾病产生什么影响，以及这些治疗方法有哪些风险。
