Elliott Sean P, Meng Maxwell V, Elkin Eric P, McAninch Jack W, Duchane Janeen, Carroll Peter R
Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Urol. 2007 Aug;178(2):529-34; discussion 534. doi: 10.1016/j.juro.2007.03.126. Epub 2007 Jun 13.
We determined the incidence of treatment for urethral stricture, including bladder neck contracture, after primary treatment for clinically localized prostate cancer.
A total of 6,597 men with newly diagnosed, localized prostate cancer and no history of urethral stricture disease were identified in the CaPSURE database. Treatment modalities included radical prostatectomy, external beam radiotherapy, brachytherapy, cryotherapy, androgen deprivation therapy, radical prostatectomy plus external beam radiotherapy, brachytherapy plus external beam radiotherapy and watchful waiting. The database was queried for patient reported history or International Classification of Diseases, 9th revision/Common Procedural Terminology codes consistent with stricture treatment after prostate cancer therapy. Time to obstruction was examined by the Kaplan-Meier method. Risk factors for stricture were examined in a multivariate Cox proportional hazards model.
The incidence of stricture treatment was 344 of 6,597 cases (5.2%, range 1.1% to 8.4% by prostate cancer treatment type). Median followup was 2.7 years. In the multivariate model primary treatment type (p <0.0001), body mass index (p <0.0001) and age (p = 0.0002) were significant predictors of stricture treatment. After controlling for age and body mass index the HR for treatments compared to watchful waiting was significantly higher for radical prostatectomy (HR = 10.4, p <0.0001) and brachytherapy plus external beam radiotherapy (HR = 4.6, p = 0.0231). After radical prostatectomy most failures occurred within the first 6 months and failures were rare after 24 months, whereas after radiation failures occurred later.
The risk of urethral stricture treatment after prostate cancer therapy is 1.1% to 8.4% depending on cancer treatment type. Risk was highest after radical prostatectomy or brachytherapy plus external beam radiotherapy and in those with advanced age or obesity. Stricture after radical prostatectomy occurred within the first 24 months, whereas onset was delayed after radiation.
我们确定了临床局限性前列腺癌初次治疗后尿道狭窄（包括膀胱颈挛缩）的治疗发生率。
在CaPSURE数据库中识别出6597例新诊断的局限性前列腺癌且无尿道狭窄疾病史的男性患者。治疗方式包括根治性前列腺切除术、外照射放疗、近距离放射治疗、冷冻治疗、雄激素剥夺治疗、根治性前列腺切除术加外照射放疗、近距离放射治疗加外照射放疗以及观察等待。查询数据库以获取患者报告的病史或与前列腺癌治疗后狭窄治疗一致的国际疾病分类第9版/通用程序术语编码。采用Kaplan-Meier方法检查梗阻时间。在多变量Cox比例风险模型中检查狭窄的危险因素。
6597例病例中有344例接受了狭窄治疗（5.2%，根据前列腺癌治疗类型，范围为1.1%至8.4%）。中位随访时间为2.7年。在多变量模型中，初次治疗类型（p<0.0001）、体重指数（p<0.0001）和年龄（p = 0.0002）是狭窄治疗的显著预测因素。在控制年龄和体重指数后，与观察等待相比，根治性前列腺切除术（HR = 10.4，p<0.0001）和近距离放射治疗加外照射放疗（HR = 4.6，p = 0.0231）的治疗HR显著更高。根治性前列腺切除术后，大多数失败发生在最初6个月内，24个月后很少出现失败，而放射治疗后失败出现较晚。
前列腺癌治疗后尿道狭窄治疗的风险为1.1%至8.4%，取决于癌症治疗类型。根治性前列腺切除术或近距离放射治疗加外照射放疗后以及年龄较大或肥胖者的风险最高。根治性前列腺切除术后的狭窄发生在最初24个月内，而放射治疗后发病延迟。
