Crook Juanita, McLean Michael, Catton Charles, Yeung Ivan, Tsihlias John, Pintilie Melania
Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2002 Feb 1;52(2):453-60. doi: 10.1016/s0360-3016(01)02658-x.
To look for factors predictive of acute urinary retention (AUR) after permanent seed prostate brachytherapy.
From March 1999 to February 2001, 150 permanent seed prostate implants were performed at Princess Margaret Hospital (Stage T1c, n = 113; T2a, n = 37; mean prostate-specific antigen level 5.9 ng/mL, prescription dose 145 Gy per Task Group No. 43). alpha-Blockers were used routinely after implantation. Dosimetry was based on the 1-month postimplant CT scan. The International Prostate Symptom Score (IPSS) and catheterization were recorded at 1 month and 3 months and then every 3 months. The following variables were examined: age, baseline IPSS, prior androgen ablation, prostate transrectal ultrasound volume, number of seeds, D(90), V(100), V(200), and urethral dose.
Twenty patients (13%) experienced AUR. No difference was seen in the mean D(90) (149 Gy vs. 152 Gy, p = 0.6), V(100) (90% vs. 91%, p = 0.6), V(200) (23% vs. 25% p = 0.4), IPSS (6.4 vs. 5.9, p = 0.8), or maximal urethral dose (204 Gy vs. 210 Gy, p = 0.5). The prostate volume was significantly larger in men with AUR (39.8 cm(3) vs. 34.3 cm(3), p = 0.003), and the mean number of seeds was higher (112 vs. 103, p = 0.006). Of the 20 patients experiencing AUR, 11 (55%) had received prior antiandrogen therapy to downsize their prostates vs. 35 (27%) of the 130 who did not have AUR (p = 0.02). Multivariate analysis showed prostate volume and prior hormone use to be independent predictors of AUR.
Implant quality as determined by D(90), V(100), V(200), and urethral dose did not predict AUR. Prostate size was the major determinant of AUR. For any given prostate size, prior androgen ablation increased the risk of AUR. Men with larger prostates should be aware of the increased risk when contemplating brachytherapy.
寻找永久性前列腺粒子植入术后急性尿潴留（AUR）的预测因素。
1999年3月至2001年2月，玛格丽特公主医院共进行了150例永久性前列腺粒子植入术（T1c期，n = 113；T2a期，n = 37；平均前列腺特异性抗原水平5.9 ng/mL，根据第43任务组的规定处方剂量为145 Gy）。植入术后常规使用α受体阻滞剂。剂量测定基于植入后1个月的CT扫描。在1个月和3个月时记录国际前列腺症状评分（IPSS）和导尿情况，之后每3个月记录一次。检查了以下变量：年龄、基线IPSS、既往雄激素剥夺治疗、经直肠超声测定的前列腺体积、粒子数量、D(90)、V(100)、V(200)和尿道剂量。
20例患者（13%）发生AUR。在平均D(90)（149 Gy对152 Gy，p = 0.6）、V(100)（90%对91%，p = 0.6）、V(200)（23%对25%，p = 0.4）、IPSS（6.4对5.9，p = 0.8）或最大尿道剂量（204 Gy对210 Gy，p = 0.5）方面未发现差异。发生AUR的男性前列腺体积明显更大（39.8 cm³对34.3 cm³，p = 0.003），平均粒子数量更高（112对103，p = 0.006）。在20例发生AUR的患者中，11例（55%）曾接受过抗雄激素治疗以缩小前列腺体积，而在未发生AUR的130例患者中有35例（27%）接受过抗雄激素治疗（p = 0.02）。多因素分析显示前列腺体积和既往激素使用是AUR的独立预测因素。
由D(90)、V(100)、V(200)和尿道剂量所确定的植入质量不能预测AUR。前列腺大小是AUR的主要决定因素。对于任何给定的前列腺大小，既往雄激素剥夺治疗会增加AUR的风险。前列腺较大的男性在考虑近距离放射治疗时应意识到风险增加。
