中西醫結合治療男性攝護腺癌合併多發性骨轉移病案

A Case Report of Prostatic Cancer with Multiple Bone Metastasis Treated with Combination of Traditional Chinese Medicine and Western Medicine

10.6516/TJTCM.201809_21(2).0019

黃志男(Chih-Nan Huang)；陳稼洺(Jia-Ming Chen)

中西醫結合 ； 攝護腺癌 ； 多發性骨轉移 ； PSA ； 散腫潰堅湯 ； Integrative Medicine ； Prostatic cancer ； multiple bone metastasis ； PSA ； San Zhong Kwei Jien Tang

中醫藥研究論叢

21卷2期（2018 / 09 / 30）

221 - 232

繁體中文

案例這位58歲男性，於2013年8月14日因下腹痛、便秘等症狀急診至彰基醫院，並被診斷為攝護腺癌合併多發性骨轉移，即第四期攝護腺癌。一般末期攝護腺癌平均存活率只剩下3.5年，此時只能靠荷爾蒙療法、放射線療法、化學治療延續生命。本病案於2013/8～2015/8二年間，以放射線療法結合荷爾蒙療法，2015/8～2015/12進行第一階段化學療法（taxotere），因產生身倦、汗多、嘔逆、便秘諸多不適症狀，於2015 年12 月經西醫泌尿科醫師推薦，合併中醫治療其放、化療之副作用，經中藥介入後身倦、汗多、嘔逆、便秘症狀大幅改善，且PSA（前列腺特異抗原，prostate specificantigen）＜4 ng/mL維持長達一年半，但2017 年5 月起發現PSA 開始升高，於2017年6月開始進行第二階段化學療法（taxotere），泌尿科醫師原考慮要換化療藥進一步治療，而在此期間患者希望中醫能提供協助，改善癌症復發的問題。經中醫辨證論治後處以散腫潰堅湯加減，協同泌尿科醫師於第二次化療期間使用化療藥taxotere相同劑量，於2017年八月PSA開始降低，之後維持在理想值PSA＜4 ng/mL，也停止了化學治療，目前仍於中、西門診持追蹤治療，病患生理狀況良好，可正常從事一般性質活動，積極配合後續的醫療追踪及處置。

The 58-year-old man of this case had no obvious symptoms before he was diagnosed with prostate cancer, the diagnosis on 2013/8 had found that the cancer has metastasized to end-stage prostate cancer complicated with multiple bone metastases. Generally, end-stage prostate cancer patients aren't able to live over 3.5 years, under such circumstance, the only ways to extend life are hormone therapy, radiotherapy, and chemotherapy. The patient was continuously treated with combination of radiotherapy and hormonal therapy from 2013/8 to 2015/8, and 2015/8~2017/12 for the first phase of chemotherapy (taxotere). Due to a number of discomfort symptoms: tired, sweat, vomit inverse, constipation, urologists recommended to merge traditional Chinese medicine into treatment to treat the side effects caused by radiotherapy and chemotherapy. Symptoms including tired, sweat, vomit inverse, constipation and PSA (prostate specific antigen ＜4 ng/mL) stability were significantly improved for up to 1.5 years after the intervention of Chinese medicine. However, it was found that the PSA began to rise in May 2017, so the second phase of the taxotere was started in June 2017. Urologists originally considered the need for further treatment with chemotherapeutic drugs, and during this period the patient hoped that the Chinese medicine practitioners could provide assistance in resisting the recurrence of cancer. We prescribed the San Zhong Kwei Jien Tang by syndrome differentiation and treatment of traditional Chinese medicine, and collaborate with Urology physicians during the second chemotherapy by using the same dose of chemotherapy drug (taxotere). The PSA began to drop in August 2017/9 and maintained within the desired value PSA＜4 ng/mL, the chemotherapy was also stopped. The patient is still in the urology and Chinese medicine clinics follow-up treatment, his physical condition is good enough to engage in normal activities.

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