Stock R G, Stone N N, Iannuzzi C
Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Int J Radiat Oncol Biol Phys. 1996 May 1;35(2):267-72. doi: 10.1016/0360-3016(95)02050-0.
The effect of a therapeutic modality on sexual potency is often an important consideration for patients choosing a treatment for prostate cancer. We prospectively assessed patients' penile erectile function before and following interactive ultrasound-guided transperineal permanent radioactive seed implantation to determine its effect on sexual function.
Eighty-nine patients underwent permanent radioactive seed implantation from June 1990 to April 1994 for localized prostate cancer (T1-T2) and were followed for a median of 15 months (1.5-52 months). 125I seeds were implanted in 73 patients with a combined Gleason grade of 2-6, and 103Pd seeds were implanted in 16 patients with higher grade lesions. The sexual potency of these patients was assessed prior to, at 3 and 6 months, and every 6 months after implantation. Erectile function was graded using a numerical score of 0 to 3 (0 = impotent (no erections), 1 = ability to have erections but insufficient for vaginal penetration, 2 = erectile function sufficient for vaginal penetration but suboptimal, 3 = normal erectile function). The pretreatment potency scores were as follows: 0 in 24 patients, 1 in 6 patients, 2 in 22 patients, and 3 in 37 patients.
The actuarial impotency rates (score = 0) following implantation for those patients possessing some degree of erectile function prior to implantation (65 patients) were 2.5% at 1 year and 6% at 2 years. The actuarial decrease in sexual function rates (a drop in score of at least one point) were 29% at 1 year and 39% at 2 years. Only two patients became impotent following treatment and this occurred at 1 year and 16 months. The time period for a decrease in erectile function to occur ranged from 1.8 months to 32.7 months, with a median of 6.8 months. Patients with higher grade tumors showed a greater decrease in potency score compared to patients with lower grade tumors.
Interactive ultrasound-guided transperineal brachytherapy for the treatment of localized prostate cancer is associated with preservation of erectile function in the vast majority of patients, although a minor decrease in potency is not uncommon.
对于选择前列腺癌治疗方法的患者而言，一种治疗方式对性功能的影响通常是一个重要的考量因素。我们前瞻性地评估了患者在超声引导下经会阴永久性放射性粒子植入术前后的阴茎勃起功能，以确定其对性功能的影响。
1990年6月至1994年4月，89例患者因局限性前列腺癌（T1-T2）接受了永久性放射性粒子植入术，并接受了中位时间为15个月（1.5-52个月）的随访。73例Gleason分级为2-6级的患者植入了125I粒子，16例高分级病变患者植入了103Pd粒子。在植入前、植入后3个月和6个月以及之后每6个月对这些患者的性功能进行评估。勃起功能采用0至3的数字评分进行分级（0 = 阳痿（无勃起），1 = 有勃起能力但不足以插入阴道，2 = 勃起功能足以插入阴道但不理想，3 = 正常勃起功能）。治疗前的功能评分如下：24例患者为0分，6例患者为1分，22例患者为2分，37例患者为3分。
对于植入前具有一定程度勃起功能的患者（65例），植入后的精算阳痿发生率（评分 = 0）在1年时为2.5%，在2年时为6%。性功能精算下降率（评分至少下降1分）在1年时为29%，在2年时为39%。只有2例患者在治疗后出现阳痿，分别发生在1年和16个月。勃起功能下降发生的时间段为1.8个月至32.7个月，中位时间为6.8个月。与低分级肿瘤患者相比，高分级肿瘤患者的功能评分下降幅度更大。
超声引导下经会阴近距离放射治疗局限性前列腺癌与绝大多数患者勃起功能的保留相关，尽管性功能略有下降并不罕见。
