Miyake Makito, Tanaka Nobumichi, Asakawa Isao, Hori Shunta, Morizawa Yosuke, Tatsumi Yoshihiro, Nakai Yasushi, Inoue Takeshi, Anai Satoshi, Torimoto Kazumasa, Aoki Katsuya, Hasegawa Masatoshi, Fujii Tomomi, Konishi Noboru, Fujimoto Kiyohide
Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan.
Department of Radiation Oncology, Nara Medical University, Nara, Japan.
BMC Urol. 2017 Aug 14;17(1):62. doi: 10.1186/s12894-017-0251-1.
The aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated.
Changes in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value.
A clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce.
To our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome.
本研究旨在评估膀胱过度活动症症状评分（OABSS）和国际前列腺症状评分（IPSS）联合使用作为碘 - 125（I）粒子植入近距离放射治疗后尿路症状复发评估工具的效果。研究了尿路症状复发与前列腺特异性抗原（PSA）反弹之间的关联。
前瞻性记录355例接受粒子植入患者的IPSS和OABSS变化。根据症状复发峰值与植入后最低点之间的差异绘制患者的百分比分布，以确定评分的显著增加。比较无复发组和复发组的临床病理特征、治疗参数和植入后剂量学参数。PSA反弹定义为与先前最低值相比升高≥0.1 ng/mL或≥0.4 ng/mL，随后降至反弹前值或更低水平。
根据总分和生活质量指数的时间进程分析，临床上显著增加要求IPSS至少增加12分，OABSS至少增加6分。仅通过IPSS评估未能检测出40例（11%）根据OABSS有尿路症状复发的患者。单因素和多因素分析显示，接受较高生物等效剂量治疗的患者和无糖尿病患者尿路症状复发风险较高。尿路症状复发发作的发生率和时间与PSA反弹的发生率和时间之间无统计学相关性。
据我们所知，这是第一份证明OABSS作为粒子植入后尿路症状复发评估工具临床潜力的报告。我们的研究结果表明，粒子植入后持续的下尿路症状归因于储尿而非排尿问题。我们认为，OABSS与IPSS联合评估将有助于在时机选择、治疗干预选择和结果评估方面进行决策。
