Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Strahlenther Onkol. 2013 Jun;189(6):476-81. doi: 10.1007/s00066-013-0323-4. Epub 2013 Apr 21.
Postprostatectomy radiotherapy (RT) improves survival in adjuvant and salvage settings. The implantation technique and complications rate of gold markers in the prostate bed for high-precision RT were analyzed.
Patients undergoing postprostatectomy RT for prostate-specific antigen (PSA) relapse or high-risk disease were enrolled in the study. Under transrectal ultrasound guidance, three fine gold markers were implanted in the prostate bed and the technical difficulties of insertion were documented. Patients received our self-designed questionnaires concerning complications and pain. The influence of anticoagulants and coumarins on bleeding was analyzed, as was the effect of potential risk factors on pain.
In 77 consecutive patients, failure of marker implantation or marker migration was seen in six cases. Rectal bleeding was reported by 10 patients and 1 had voiding complaints. No macroscopic hematuria persisting for more than 3 days was observed. Other complications included rectal discomfort (n = 2), nausea (n = 1), abdominal discomfort (n = 1), and pain requiring analgesics (n = 4). No major complications were reported. On a 0-10 visual analogue scale (VAS), the mean pain score was 3.7. No clinically significant risk factors for complications were identified.
Transrectal implantation of gold markers in the prostate bed is feasible and safe. Alternatives like cone beam computed tomography (CBCT) should be considered, but the advantages of gold marker implantation for high-precision postprostatectomy RT would seem to outweigh the minor risks involved.
前列腺癌根治术后放疗（RT）可改善辅助和挽救治疗中的生存情况。本研究分析了前列腺床内金标记物在高精度 RT 中的植入技术和并发症发生率。
本研究纳入了因前列腺特异抗原（PSA）复发或高危疾病而行前列腺癌根治术后 RT 的患者。在经直肠超声引导下，将三根细金标记物植入前列腺床内，并记录插入的技术难度。患者接受了我们自行设计的有关并发症和疼痛的问卷。分析了抗凝剂和香豆素类药物对出血的影响，以及潜在危险因素对疼痛的影响。
在 77 例连续患者中，有 6 例出现标记物植入失败或标记物迁移。10 例患者报告出现直肠出血，1 例患者出现排尿困难。未观察到持续 3 天以上的肉眼血尿。其他并发症包括直肠不适（n=2）、恶心（n=1）、腹部不适（n=1）和需要止痛药的疼痛（n=4）。无重大并发症报告。疼痛评分采用 0-10 视觉模拟评分（VAS），平均评分为 3.7。未发现并发症的有临床意义的危险因素。
经直肠植入前列腺床内的金标记物是可行且安全的。应考虑锥形束 CT（CBCT）等替代方法，但金标记物植入术在高精度前列腺癌根治术后 RT 中的优势似乎超过了其涉及的轻微风险。
