St. Luke's Cancer Centre, Guildford, UK.
BJU Int. 2018 Oct;122(4):610-617. doi: 10.1111/bju.14223. Epub 2018 May 8.
To report clinical outcomes of I low-dose-rate prostate brachytherapy (LDR-PB) as monotherapy or combined with androgen-deprivation therapy (ADT) and/or external beam radiotherapy (EBRT) in high-risk localised prostate cancer.
Analysis of clinical outcomes from a prospective cohort of patients treated with LDR-PB alone or combined treatment in a single institution. Men with a high risk of disease relapse were identified by the National Institute for Health and Care Excellence (NICE) criteria or by the National Comprehensive Cancer Network (NCCN) criteria. Relapse-free survival (RFS), overall survival (OS), prostate cancer-specific survival (PCSS), and metastases-free survival (MFS), were analysed together with patient-reported symptom scores and physician-reported adverse events.
The NICE and NCCN criteria identified 267 and 202 high-risk patients, respectively. NICE-defined patients had significantly lower pre-treatment PSA levels, Gleason scores <7, and a greater proportion of patients who received LDR-PB monotherapy. At 9 years after implantation RFS was 89% and 87% in the NICE and NCCN groups, respectively (log-rank P = 0.637), and OS 93% and 94%, respectively (log-rank P = 0.481). All of the survival estimates were similar between LDR-PB monotherapy and combined therapies. Cox proportional hazards regression confirmed RFS was similar between the treatment types. Treatment-related toxicity was also similar between the treatment methods.
LDR-PB is effective at controlling localised prostate cancer in patients with a high risk of disease relapse. As the present study was not randomised, it is not possible to define those patients who need the addition of ADT and/or EBRT. However, the NICE criteria appear suitable to define treatment options where patients could benefit from LDR-PB as monotherapy or combined treatment. This choice should be discussed with the patient taking into account comorbidities and presence of multiple high-risk factors.
报告低剂量率前列腺近距离放射治疗（LDR-PB）作为单一疗法或联合雄激素剥夺治疗（ADT）和/或外部束放射治疗（EBRT）在高危局限性前列腺癌中的临床结果。
分析了单中心接受 LDR-PB 单一治疗或联合治疗的前瞻性队列患者的临床结果。通过国家卫生与保健卓越研究所（NICE）标准或国家综合癌症网络（NCCN）标准，确定疾病复发风险高的患者。无复发生存（RFS）、总生存（OS）、前列腺癌特异性生存（PCSS）和无转移生存（MFS）与患者报告的症状评分和医生报告的不良事件一起进行分析。
NICE 和 NCCN 标准分别确定了 267 名和 202 名高危患者。NICE 定义的患者治疗前 PSA 水平、Gleason 评分<7 和接受 LDR-PB 单一治疗的患者比例明显较低。植入后 9 年时，NICE 和 NCCN 组的 RFS 分别为 89%和 87%（对数秩 P = 0.637），OS 分别为 93%和 94%（对数秩 P = 0.481）。LDR-PB 单一治疗与联合治疗的所有生存估计值相似。Cox 比例风险回归证实治疗类型之间 RFS 相似。治疗相关毒性在治疗方法之间也相似。
LDR-PB 对控制高危复发风险的局限性前列腺癌有效。由于本研究不是随机的，因此无法确定需要添加 ADT 和/或 EBRT 的患者。然而，NICE 标准似乎适合定义治疗方案，使患者受益于 LDR-PB 作为单一治疗或联合治疗。在考虑到合并症和存在多种高危因素的情况下，应与患者讨论该选择。
