Henderson A, Ismail A K A, Cunningham M, Aldridge S, Loverock L, Langley S E M, Laing R W
St Luke's Cancer Centre, Guildford, Surrey, UK.
Clin Oncol (R Coll Radiol). 2004 Apr;16(2):95-104. doi: 10.1016/j.clon.2003.11.006.
Transperineal interstitial prostate brachytherapy is increasingly available to patients with early prostate cancer in the U.K., but limited data are available about the toxicity and early results in the U.K. prostate cancer population. We describe our experience and results from prostate brachytherapy to date.
Two hundred and fifty-five patients were treated at St Luke's Cancer Centre, Guildford, U.K., between March 1999 and November 2002. Of these, over 3 months of follow-up data were available for 216 patients. Patients were assessed at 6 weeks and then at 3, 6, 9 and 12 months after implant, and at 6 monthly intervals thereafter. Prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and toxicity, including catheter use, was recorded prospectively.
Median PSA at 1, 2 and 3 years was 0.5, 0.4 and 0.1 ng/ml, respectively. Ninety-five per cent of patients experienced temporary deterioration in their urinary symptoms, which persisted at clinically significant levels (IPSS increase >3 points) for 9 months after implant. The severity of urinary symptoms (IPSS) after implant was most closely related to IPSS at presentation (P<0.001). Acute urinary retention (AUR) occurred in 20 (9.3%) patients, with a further 26 (12.1%) patients using clean intermittent self-catheterisation (CISC) to reduce voiding frequency associated with chronic retention. Median duration of catheter use was 4 weeks. Multivariate analysis revealed that urodynamic status, prostate volume and IPSS score were independently significant (P<0.05) predictors of post-implant catheter use. Twelve patients (5.6%) reported either rectal urgency or mild, self-limiting rectal bleeding.
Brachytherapy was tolerated well, with self-limiting urinary, bowel and sexual toxicity in most patients. Postoperative catheter use in our population is closely linked to pre-implant IPSS score, baseline prostate volume and urodynamic obstruction status. This work confirms the prognostic value of urodynamic assessment, which adds useful prognostic information to assessment of known risk factors such as prostate volume and IPSS.
在英国，经会阴间质前列腺近距离放射治疗越来越多地应用于早期前列腺癌患者，但关于英国前列腺癌患者群体的毒性和早期结果的数据有限。我们描述了迄今为止前列腺近距离放射治疗的经验和结果。
1999年3月至2002年11月期间，英国吉尔福德圣卢克癌症中心对255例患者进行了治疗。其中，216例患者有超过3个月的随访数据。患者在植入后6周进行评估，然后在3、6、9和12个月时评估，此后每6个月评估一次。前瞻性记录前列腺特异性抗原（PSA）、国际前列腺症状评分（IPSS）和毒性，包括导管使用情况。
1年、2年和3年时的PSA中位数分别为0.5、0.4和0.1 ng/ml。95%的患者出现了尿路症状的暂时恶化，植入后9个月内这些症状在临床上仍处于显著水平（IPSS增加>3分）。植入后尿路症状的严重程度（IPSS）与就诊时的IPSS最为密切相关（P<0.001）。20例（9.3%）患者发生急性尿潴留（AUR），另有26例（12.1%）患者使用清洁间歇性自我导尿（CISC）来减少与慢性尿潴留相关的排尿频率。导管使用的中位持续时间为4周。多因素分析显示，尿动力学状态、前列腺体积和IPSS评分是植入后导管使用的独立显著（P<0.05）预测因素。12例（5.6%）患者报告有直肠紧迫感或轻度、自限性直肠出血。
近距离放射治疗耐受性良好，大多数患者存在自限性的泌尿、肠道和性功能毒性。我们研究人群中术后导管的使用与植入前IPSS评分、基线前列腺体积和尿动力学梗阻状态密切相关。这项工作证实了尿动力学评估的预后价值，它为前列腺体积和IPSS等已知风险因素的评估增加了有用的预后信息。
