Stone Nelson N, Stock Richard G
Department of Urology, Mount Sinai School of Medicine, New York, New York, USA.
Urology. 2007 Feb;69(2):338-42. doi: 10.1016/j.urology.2006.10.001.
To define the long-term morbidity in patients with prostate cancer who underwent iodine-125 brachytherapy.
A total of 325 men with localized prostate cancer treated with iodine-125 brachytherapy had a median follow-up of 7 years (range 5 to 15). The American Urological Association symptom score, erectile function status, rectal bleeding incidence, and presence of urinary incontinence were collected prospectively before implantation and every 6 months thereafter. Comparisons were made between the pretreatment and treatment-related factors and their associations with quality-of-life changes. Associations were tested using the Student t, chi-square, and Wilcoxon signed rank tests.
The median prostate volume and maximal dose to 90% of the prostate was 36.6 cm3 and 167 Gy, respectively. Of the 325 men, 15.7% experienced prostate-specific antigen failure and 4% started androgen deprivation therapy. The mean total symptom and bother scores increased from baseline (P <0.001) to 6 months after implantation, steadily decreased, and were unchanged at the last follow-up visit (P = 0.6). There were no significant associations among patient age, race, hormonal therapy use, prostate size, radiation dose, and urinary morbidity. Incontinence occurred in 4 (1.2%) of the 325 patients at the last follow-up visit and was associated with transurethral resection of the prostate (odds ratio 8.8, 95% confidence interval 1.3 to 62, P = 0.008). Before implantation, 77.2% were able to have an erection adequate for intercourse and 50.6% were able to at the last follow-up visit. A significant correlation was found between potency preservation and age (P <0.001). Rectal bleeding occurred in 78 men (24%) 1 to 3 years after implantation. Nine patients (2.8%) complained of minor bleeding beyond 5 years, which was associated with greater radiation doses (P = 0.023).
The preservation of urinary, sexual, and rectal quality of life is excellent at long follow-up for patients implanted with iodine-125.
明确接受碘 - 125近距离放射治疗的前列腺癌患者的长期发病率。
共有325例接受碘 - 125近距离放射治疗的局限性前列腺癌男性患者，中位随访时间为7年（范围5至15年）。前瞻性收集植入前及此后每6个月的美国泌尿外科学会症状评分、勃起功能状态、直肠出血发生率及尿失禁情况。对治疗前和治疗相关因素及其与生活质量变化的关联进行比较。使用学生t检验、卡方检验和威尔科克森符号秩检验进行相关性检验。
前列腺中位体积和前列腺90%的最大剂量分别为36.6 cm³和167 Gy。325例男性患者中，15.7%出现前列腺特异性抗原失败，4%开始雄激素剥夺治疗。总症状和困扰评分均值从基线（P <0.001）至植入后6个月升高，随后稳步下降，末次随访时无变化（P = 0.6）。患者年龄、种族、激素治疗使用情况、前列腺大小、放射剂量与泌尿疾病发病率之间无显著关联。末次随访时，325例患者中有4例（1.2%）出现尿失禁，且与经尿道前列腺切除术相关（比值比8.8，95%置信区间1.3至62，P = 0.008）。植入前，77.2%的患者勃起功能足以进行性交，末次随访时为50.6%。发现勃起功能保留与年龄之间存在显著相关性（P <0.001）。78例男性患者（24%）在植入后1至3年出现直肠出血。9例患者（2.8%）在5年后出现轻微出血，这与更高的放射剂量相关（P = 0.023）。
对于接受碘 - 125植入治疗的患者，长期随访时泌尿、性功能和直肠生活质量的保留情况良好。
