Tremblay Guillaume, Nguyen Truong An, Marolleau Julien, Malhaire Jean-Pierre, Fourcade Alexandre, Boussion Nicolas, Goasduff Gaelle, Martin Emmanuelle, Dissaux Gurvan, Pradier Olivier, Fournier G, Schick U, Valeri Antoine
Urology Department, CHU, Brest, France.
Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.
J Contemp Brachytherapy. 2023 Apr;15(2):89-95. doi: 10.5114/jcb.2023.127049. Epub 2023 Apr 28.
As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients.
From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively.
The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 ( = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities.
For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.
由于前列腺近距离放射治疗（BT）对低风险（LR）或有利的中风险（FIR）前列腺癌（PCa）的肿瘤学效果极佳，评估其副作用已成为一个主要问题，尤其是对于年轻男性。本研究的目的是比较使用Quadrella指数评估60岁及以下患者与老年患者接受BT后的肿瘤学和功能结果。
2007年6月至2017年6月，222例患者接受了LR - FIR PCa的BT治疗，其中70例年龄≤60岁，152例年龄>60岁，根据国际勃起功能指数-5（IIEF - 5）>16，基线时勃起功能良好。Quadrella指数在以下情况下实现：1）无生物学复发（凤凰标准）；2）无勃起功能障碍（ED）（IIEF - 5>16）；3）无泌尿毒性（国际前列腺症状评分）IPSS<15或IPSS>15且ΔIPSS<5；4）无直肠毒性（RT）（放射治疗肿瘤学组，RTOG = 0）。术后根据需要对患者使用磷酸二酯酶抑制剂（PDE5i）进行治疗。
在6年随访期间，60岁及以下患者中约40 - 80%满足Quadrella指数，而老年患者为33 - 46%（从第二年起有显著差异）。在第5年，100%的60岁及以下可评估患者和91.8%的>60岁患者（P = 0.29）达到凤凰标准。ED标准（IIEF - 5<16）在很大程度上解释了单独Quadrella指数的有效率。60岁及以下患者中67.2 - 81.4%无ED，而>60岁患者为40.0 - 56.1%（自第4年起有显著差异，有利于年轻男性）。随访两年后，两组中超过90%的患者既无泌尿毒性也无直肠毒性。
对于患有LR - FIR PCa的年轻男性，BT似乎是一种一流的治疗选择，因为其肿瘤学结果至少与老年患者相当，且长期耐受性良好。
