Use of combined androgen deprivation therapy with postoperative radiation treatment for prostate cancer: Impact of randomized trials on clinical practice

Postoperative Effect Observation and Clinical Study of Dahuang Zhechong Pills from Jingui Yaolue in Treating Patients with Early-to-Mid Prostate Cancer Undergoing Radical Resection

Objective

To explore the effect of applying Dahuang Zhechong pills (DHZCP) from Jingui Yaolue to patients with early-to-mid prostate cancer undergoing radical resection and carry out a theoretical clinical study of traditional Chinese medicine (TCM) to verify the effect of DHZCP formula under the guidance of TCM theory.

Methods

The clinical data of 98 patients with early-to-mid prostate cancer undergoing radical resection treated in our hospital (July 2014 to July 2016) were selected for the retrospective analysis, and the patients were divided into group A (n = 49, routine hormonal therapy) and group B (n = 49, routine hormonal therapy plus DHZCP) according to the double blind method, so as to compare the trauma symptoms, cancer recurrence rate, etc., after treatment between the two groups.

Results

Compared with group A, group B obtained significantly higher total effective rate of complication treatment at different time points (P < 0.05), significantly lower mean HAMA score after treatment (P < 0.05), and significantly lower total recurrence rate (P < 0.05). The "congestion" theory in Chapter VI On Pulse, Symptom Complex and Treatment of Arthralgia Due to Stagnation of Blood and Consumptive Diseases of Jingui Yaolue was the theoretical basis for postoperative effect observation of DHZCP in treating prostate cancer. Combining with the onset theory of congestion, personally, the author believed that cancer is caused by congestion disease formed by the extravasated blood in the human body, and with the passing of time, the intermingled deficiency, blood stasis, and toxicity lead to the qualitative change of endogenous cancer toxicity and develop into consumptive congestion disease, making it the core pathogenesis of cancer. And DHZCP had good preventive and treatment effect.

Conclusion

DHZCP is an effective drug for improving postoperative complications of early-to-mid prostate cancer, reducing the biological recurrence rate and clinical recurrence rate, and improving mental status. The formula treats both deficiency and excess, combines tonification with purgation, and dispels exogenous pathogen without damaging body resistance, which is a profound formula based on TCM theory to treat "congestion," "congestion disease," and "consumptive congestion disease." Using this theory to guide clinical syndrome differentiation and treatment and modifying the dosage and usage can play an important role in TCM preventive treatment of cancers, early, middle, and late treatment, and clinical prevention of other chronic diseases.

Salvage therapy for prostate cancer after radical prostatectomy

More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.