Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
BJU Int. 2018 Nov;122(5):831-836. doi: 10.1111/bju.14365. Epub 2018 May 31.
To determine which patient and treatment-related factors are associated with increased American Urological Association symptom score (AUASS) in men who presented with minimal symptoms before treatment for prostate cancer by permanent seed implantation.
Of 1842 men with a minimum follow-up of 5 years (mean 9.4), 1110 (60.3%) had an initial AUASS of 0-7 and were treated with brachytherapy (BT) alone (n = 491) or BT with neoadjuvant hormone therapy (NHT) and/or external beam radiation therapy (EBRT, n = 619). The median prostate volume was 37 mL. Data were prospectively collected on comorbidities. Initial AUASS was compared to last using a Student's t-test (two-tailed). Freedom from increasing from minimal to moderate or severe symptoms was determined by the Kaplan-Meier method with comparisons by log-rank and Cox hazard rates (HRs).
The change from pre-treatment score for the minimal, moderate and severe symptom groups was: 3.6-7.3 (P < 0.001), 11.6-11.3 (P = 0.426), and 24.1-16.9 (P < 0.001). For those with minimal symptoms the 10- and 15-year estimates for freedom from worse symptoms were 72.9% and 39.1%, respectively. Cox HRs were significant for EBRT boost (HR 1.45, P = 0.004), RT dose >200 Gy (HR 1.25, P = 0.024), hypertension (HR 1.37, P = 0.006), and alcohol use (HR 1.46, P = 0.001).
A substantial number of men with initial low AUASS treated by BT experience worsening urinary symptoms with long-term follow-up. Use of EBRT, RT dose, hypertension and alcohol use are risk factors for an increase in urinary symptom score.
确定哪些患者和治疗相关因素与接受永久性种子植入治疗前列腺癌的男性在治疗前有轻微症状时的美国泌尿外科学会症状评分（AUASS）增加有关。
在 1842 名至少随访 5 年（平均 9.4 年）的男性中，有 1110 名（60.3%）初始 AUASS 为 0-7，单独接受近距离放射治疗（BT）治疗（n=491）或 BT 联合新辅助激素治疗（NHT）和/或外部束放射治疗（EBRT，n=619）。前列腺体积中位数为 37mL。前瞻性收集合并症数据。使用学生 t 检验（双侧）比较初始 AUASS 与最后一次 AUASS。通过 Kaplan-Meier 方法确定从轻微症状到中度或严重症状的无进展情况，并通过对数秩和 Cox 风险比（HR）进行比较。
轻微、中度和重度症状组的治疗前评分变化为：3.6-7.3（P<0.001）、11.6-11.3（P=0.426）和 24.1-16.9（P<0.001）。对于有轻微症状的患者，10 年和 15 年无更严重症状的估计分别为 72.9%和 39.1%。EBRT 增强（HR 1.45，P=0.004）、RT 剂量>200Gy（HR 1.25，P=0.024）、高血压（HR 1.37，P=0.006）和饮酒（HR 1.46，P=0.001）的 Cox HR 均有统计学意义。
接受 BT 治疗的初始 AUASS 较低的男性中，有相当数量的人在长期随访中出现尿症状恶化。EBRT 的使用、RT 剂量、高血压和饮酒是尿症状评分增加的危险因素。
