Alexianu M, Weiss G H
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
J Endourol. 2000 May;14(4):325-8. doi: 10.1089/end.2000.14.325.
The considerations in choosing a treatment for prostate cancer are potential for cure, acute toxicity, long-term morbidity, quality of life, and direct and indirect costs. The classic options are radical prostatectomy, external-beam radiation, and watchful waiting. During the last decade, technological advances have fostered another: brachytherapy.
This article compares brachytherapy and radical prostatectomy in terms of cancer control, complications, and cost using series from medical centers that have pioneered and advocated particular procedures.
In the surgical series from Johns Hopkins, the 7-year success rate (no PSA >0.2 ng/mL) of anatomic radical prostatectomy was 97.8% in patients with stage T(2c) or lower disease and a Gleason score of < or =6. In the brachytherapy series from Seattle, the 7-year success rate (PSA < or =0.5 ng/mL) was 79%. Postoperatively, 68% of the patients who were potent preoperatively maintained erectile function, and 92% were fully continent. Urethral toxicity is slightly more common in patients treated by brachytherapy, but in the authors' series, no patient remained incontinent after 6 months. Some patients became impotent during follow-up. The cost of brachytherapy ($16,200) is less than that of ($27,000), although the difference may be reduced by the use of neoadjuvant hormonal therapy with the former.
Patients receiving brachytherapy appear to have a slightly higher rate of disease progression. The side effects generally are acceptable and may be less severe than those of surgery. Further follow-up data are needed to define the roles of these two treatments for early-stage prostate cancer.
选择前列腺癌治疗方法时需考虑的因素包括治愈可能性、急性毒性、长期发病率、生活质量以及直接和间接成本。传统的治疗选择是根治性前列腺切除术、外照射放疗和观察等待。在过去十年中，技术进步催生了另一种治疗方法：近距离放射治疗。
本文利用率先开展并倡导特定治疗方法的医学中心的数据系列，比较了近距离放射治疗和根治性前列腺切除术在癌症控制、并发症及成本方面的差异。
在约翰霍普金斯医院的手术数据系列中，T(2c)期及以下且Gleason评分≤6的患者，解剖性根治性前列腺切除术的7年成功率（PSA>0.2 ng/mL）为97.8%。在西雅图的近距离放射治疗数据系列中，7年成功率（PSA≤0.5 ng/mL）为79%。术后，术前有性功能的患者中，68%维持了勃起功能，92%完全控尿。近距离放射治疗的患者尿道毒性略为常见，但在作者的数据系列中，6个月后无患者仍存在尿失禁。部分患者在随访期间出现阳痿。近距离放射治疗的成本（16,200美元）低于根治性前列腺切除术（27,000美元），不过前者使用新辅助激素治疗后，两者成本差异可能会缩小。
接受近距离放射治疗的患者疾病进展率似乎略高。其副作用总体上可以接受，可能比手术的副作用轻。需要进一步的随访数据来明确这两种治疗方法在早期前列腺癌治疗中的作用。
