Formenti S C, Lieskovsky G, Simoneau A R, Skinner D, Groshen S, Chen S C, Petrovich Z
Department of Radiation Oncology, University of Southern California School of Medicine, Los Angeles, USA.
J Urol. 1996 Feb;155(2):616-9.
We analyzed the impact on potency and urinary continence of moderate doses of radiation (45 to 54 Gy.) given postoperatively after nerve sparing prostatectomy.
Between 1983 and 1992, 294 of 762 prostate cancer patients were selected to undergo nerve sparing prostatectomy. Subjective patient reports regarding potency and urinary continence status were obtained preoperatively, 1 year postoperatively or 1 year after completion of radiation.
Of the 294 patients 105 received postoperative radiotherapy (45 to 54 Gy.) to the prostatic bed. There were patients with more advanced stages of disease in the irradiated group, including 89% with stages C and D1 (pT3N0 and pT1 to 3, N1 to 3), compared to 14% with stages C and D1 (pT3N0 and pT1 to 3, N1 to 3) in the nonirradiated group (p < 0.001). No difference in urinary continence was noted in the irradiated (94%) compared to the nonirradiated group (92%, p = 0.64). Of the patients who underwent bilateral nerve sparing prostatectomy 44% who received and 48% who did not receive radiation had recovered potency at 1 year (p = 0.76). Of those who underwent unilateral nerve sparing prostatectomy 10% who received and 33% who did not receive radiation had recovered potency at 1 year (p = 0.14). Using multivariate analysis patient age younger than 63 years and bilateral versus unilateral nerve sparing procedures were significant predictors of potency.
Our retrospective study suggests that at 1 year after treatment moderate doses of postoperative radiotherapy did not have a significant impact on the recovery of urinary continence and potency after nerve sparing prostatectomy. However, longer followup is required to determine the impact of this radiation protocol on long-term preservation of potency after nerve sparing prostatectomy.
我们分析了在保留神经的前列腺切除术后给予中等剂量放疗（45至54Gy）对性功能和尿失禁的影响。
1983年至1992年间，762例前列腺癌患者中有294例被选接受保留神经的前列腺切除术。术前、术后1年或放疗结束后1年获取患者关于性功能和尿失禁状况的主观报告。
294例患者中，105例接受了针对前列腺床的术后放疗（45至54Gy）。放疗组中疾病分期较晚的患者更多，其中89%为C期和D1期（pT3N0和pT1至3，N1至3），相比之下，未放疗组中C期和D1期（pT3N0和pT1至3，N1至3）的患者占14%（p<0.001）。放疗组（94%）与未放疗组（92%，p=0.64）在尿失禁方面未发现差异。在接受双侧保留神经前列腺切除术的患者中，接受放疗的患者1年后性功能恢复的比例为44%，未接受放疗的患者为48%（p=0.76）。在接受单侧保留神经前列腺切除术的患者中，接受放疗的患者1年后性功能恢复的比例为10%，未接受放疗的患者为33%（p=0.14）。多因素分析显示，年龄小于63岁以及双侧与单侧保留神经手术是性功能恢复的显著预测因素。
我们的回顾性研究表明，在治疗后1年，中等剂量的术后放疗对保留神经的前列腺切除术后尿失禁和性功能的恢复没有显著影响。然而，需要更长时间的随访来确定这种放疗方案对保留神经的前列腺切除术后性功能长期保留的影响。
