Okaneya Toshikazu, Nishizawa Shuji, Nakayama Tsuyoshi, Kamigaito Takayuki, Hashida Iwao, Hosaka Noriko
Department of Urology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, Nagano 381-8551, Japan.
Int J Urol. 2007 Jul;14(7):602-6. doi: 10.1111/j.1442-2042.2007.01782.x.
To evaluate the initial results of brachytherapy for prostate cancer with permanent iodine-125 implant in Japan.
The results obtained with brachytherapy in the initial 100 Japanese patients treated at Nagano Municipal Hospital were reviewed. Patients with a prostate-specific antigen (PSA) level of less than 10 ng/mL and a Gleason's scores of 5, 6, 3 + 4 were classified as having a low risk of recurrence. Patients with a PSA level of 10-20 ng/mL and/or a Gleason's score of 4 + 3 were classified as having an intermediate risk for recurrence. Seventy-eight of the low-risk patients and 19 of the intermediate-risk patients were treated by seed implants alone, or seed implants combined with preceding external radiation, respectively. A total of 53 patients received neoadjuvant hormone therapy. The efficacy and morbidity of brachytherapy were investigated using the serum PSA, International Prostate Symptom Score, quality of life score and uroflowmetry data.
The average V100 and D90 obtained by post-implant dosimetry was 94.3 and 113.7%, respectively. Serum PSA decreased gradually after treatment, although it had still not reached a nadir after 1 year. There was little difference of the PSA level between the patients with and without neoadjuvant hormone therapy even at 1 year after seed implantation. There were no PSA biochemical failure or clinical recurrence during the follow-up period. Voiding symptoms worsened until 3 months after treatment, and then gradually improved. Acute urinary retention occurred transiently in one patient (1%). Rectal bleeding and severe diarrhea did not occur.
Brachytherapy is a feasible and effective option for the treatment of prostate cancer in Japanese men. Brachytherapy may have a different effect in Japanese patients with respect to voiding symptoms. Urinary retention was rare, but voiding symptoms were persistent in Japanese patients. Neoadjuvant hormone therapy deserves investigation to determine whether it can achieve better results, especially in patients with an intermediate risk.
评估日本永久性碘 - 125植入近距离放射治疗前列腺癌的初步结果。
回顾了长野市立医院最初接受治疗的100例日本患者的近距离放射治疗结果。前列腺特异性抗原（PSA）水平低于10 ng/mL且Gleason评分5、6、3 + 4的患者被归类为复发风险低。PSA水平为10 - 20 ng/mL和/或Gleason评分为4 + 3的患者被归类为复发风险中等。78例低风险患者和19例中等风险患者分别单独接受粒子植入或粒子植入联合先前的外照射治疗。共有53例患者接受了新辅助激素治疗。使用血清PSA、国际前列腺症状评分、生活质量评分和尿流率数据研究近距离放射治疗的疗效和发病率。
植入后剂量测定获得的平均V100和D90分别为94.3%和113.7%。治疗后血清PSA逐渐下降，尽管1年后仍未达到最低点。即使在粒子植入后1年，接受和未接受新辅助激素治疗的患者之间PSA水平差异也不大。随访期间未发生PSA生化失败或临床复发。排尿症状在治疗后3个月内恶化，然后逐渐改善。1例患者（1%）短暂出现急性尿潴留。未发生直肠出血和严重腹泻。
近距离放射治疗是日本男性前列腺癌治疗的一种可行且有效的选择。近距离放射治疗在日本患者的排尿症状方面可能有不同的效果。尿潴留很少见，但日本患者的排尿症状持续存在。新辅助激素治疗值得研究以确定其是否能取得更好的效果，特别是在中等风险患者中。
