Flam Thierry A, Peyromaure Michaël, Chauveinc Laurent, Thiounn Nicolas, Firmin Francis, Cosset Jean-Marc, Bernard Debré
Department of Urology, Hôpital Cochin, Paris, France.
J Urol. 2004 Jul;172(1):108-11. doi: 10.1097/01.ju.0000132136.95221.63.
We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer.
From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique.
Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4).
After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.
我们评估了先前接受近距离放射治疗作为局限性前列腺癌单一疗法的患者经尿道前列腺切除术（TURP）的发生率及结果。
1998年5月至2003年5月，我院600例局限性前列腺癌患者接受了近距离放射治疗。对于临床分期为T1c（68.4%）或T2a（31.6%）疾病的患者，近距离放射治疗作为单一疗法用于临床局限性前列腺癌的根治性治疗，未进行辅助治疗。分别有583例和7例患者使用碘和钯植入物。除前17例采用预先计划技术治疗的患者外，其余所有患者均采用实时交互式植入技术。
600例患者中，19例（3.1%）在近距离放射治疗后接受了TURP。在急性尿潴留患者中，前列腺近距离放射治疗与尿潴留之间的中位间隔时间为2个月（范围0.5至32个月）。植入后6个月内未进行TURP。前列腺近距离放射治疗与TURP之间的中位间隔时间为7个月（范围6至41个月），TURP前前列腺特异性抗原（PSA）的中位值为0.5 ng/ml（范围0.04至3.4）。19例患者中，切除前列腺组织的中位重量为8克（范围2至19克），取出1至11枚种子（中位值5枚）。围手术期和术后过程顺利。无TURP相关的尿失禁。近距离放射治疗后中位随访28个月（范围7至48个月），无患者有疾病进展的临床或生化证据，19例接受TURP的患者随访结束时血清PSA的中位值为0.38 ng/ml（范围0.03至3.4）。
作为单一疗法的近距离放射治疗后，如果有指征，可以安全地进行TURP。根据我们的经验，植入后至少6个月切除前列腺组织以及少量种子不会损害基于PSA的近距离放射治疗的生物学和临床结果。
