Langley Stephen, Uribe Jennifer, Uribe-Lewis Santiago, Mehta Sheel, Mikropoulos Christos, Perna Carla, Otter Sophie, Horton Alex, Cunningham Melanie, Higgins Donna, Langley Suzanne, Deering Claire, Khaksar Sara
The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, United Kingdom.
The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, United Kingdom.
Brachytherapy. 2022 Nov-Dec;21(6):870-876. doi: 10.1016/j.brachy.2022.08.013. Epub 2022 Oct 4.
The Hemi-Ablative Prostate Brachytherapy (HAPpy) trial evaluated hemi-gland (HG) low-dose-rate prostate brachytherapy (LDR-PB) as a focal approach to control unilateral localized prostate cancer and reduce treatment-related toxicity at 2-years postimplant. Herewith we present further outcomes with a minimum of 5 years post-implant follow-up.
Outcomes of 30 HG implants and 362 whole-gland (WG) brachytherapy controls were monitored with IPSS, urinary Quality-of-Life (QoLU), GI component of EORTC-PR25 (QoLB), and IIEF-5 instruments, and PSA values. The median (range) follow-up for HG and WG cases was 72 (60-96) months and 84 (24-144) months respectively.
The IPSS was significantly reduced in HG relative to WG patients and trends indicating improved bowel QoL and erectile function were observed. The mean of change in PSA from baseline to last follow-up was -5.6 and -6.5 in HG and WG respectively (p = 0.1). The mean time to nadir was 4.2 and 4.8 years in HG and WG respectively (p = 0.06). Over time PSA in HG patients mirrored the sustained decline observed in WG cases but levels were higher by an average 0.5 ng/ml over WG controls (p < 0.001). Treatment failure occurred in 2 (6.7%) HG patients and in 20 (5.5%) WG cases. Five-year relapse-free survival was 97% in both groups (p = 0.7).
At 5 years postimplant HG LDR-PB was as effective as WG treatment for control of unilateral localized prostate cancer with moderate improvement in treatment-related symptoms. Importantly, PSA is a valuable marker to assess disease control in this form of focal therapy.
半消融前列腺近距离放射治疗（HAPpy）试验评估了半腺体（HG）低剂量率前列腺近距离放射治疗（LDR-PB）作为一种局部治疗方法，用于控制单侧局限性前列腺癌并降低植入后2年的治疗相关毒性。在此，我们展示植入后至少5年随访的进一步结果。
采用国际前列腺症状评分（IPSS）、尿生活质量（QoLU）、欧洲癌症研究与治疗组织前列腺癌生活质量问卷25项量表（EORTC-PR25）的胃肠道部分（QoLB）、国际勃起功能指数-5（IIEF-5）量表以及前列腺特异性抗原（PSA）值，对30例HG植入患者和362例全腺体（WG）近距离放射治疗对照患者的结果进行监测。HG组和WG组患者的中位（范围）随访时间分别为72（60 - 96）个月和84（24 - 144）个月。
与WG患者相比，HG患者的IPSS显著降低，且观察到肠道生活质量和勃起功能有改善趋势。HG组和WG组从基线到最后一次随访时PSA的平均变化分别为 -5.6和 -6.5（p = 0.1）。HG组和WG组达到最低点的平均时间分别为4.2年和4.8年（p = 0.06）。随着时间推移，HG患者的PSA反映出与WG病例中观察到的持续下降相似，但水平比WG对照组平均高0.5 ng/ml（p < 0.001）。2例（6.7%）HG患者和20例（5.5%）WG病例出现治疗失败。两组的5年无复发生存率均为97%（p = 0.7）。
植入后5年，HG LDR-PB在控制单侧局限性前列腺癌方面与WG治疗同样有效，且治疗相关症状有适度改善。重要的是，PSA是评估这种局部治疗中疾病控制情况的有价值指标。
