前列腺癌患者粒子植入治疗后血清PSA变化的观察

目的探讨前列腺癌患者粒子植入治疗后血清PSA变化规律.方法前列腺癌患者13例.临床分期：T1cN0M08例,T2aN0M05例;Gleason评分：5分4例,6分9例;血清PSA 2.8～14.6 ng/ml,平均8.2 ng/ml.采用125I粒子植入治疗,治疗剂量D90为140～155 Gy.术后定期复查血清PSA,观察其变化规律.结果13例患者随访3～23个月.术后1、2、3、6、9、12、15、18及21个月血清PSA中位值为6.7、5.0、2.7、1.6、1.2、0.9、0.8、0.8及0.7 ng/ml.分别为术前血清PSA中位数的72%、51%、29%、20%、13%、11%、9%、9%及8%.术后1个月30%患者血清PSA有波动.结论前列腺癌粒子植入治疗后患者血清PSA下降缓慢,早期有波动.术后1年尤其术后3个月内血清PSA下降相对较快.

Changes in serum PSA after brachytherapy for prostate cancer

Objective To evaluate the serum prostate specific antigen(PSA)change after I-125 radioactive seed implantation without androgen ablation therapy for prostate cancer,Methods A total of 13 patients with prostate cancer were included.The clinical stage was T_(1c)N_0M_0 in 8 cases,and T_(2a)N_0M_0 in 5. The Gleason scores were 5 in 4 cases and 6 in 9.The mean serum PSA was 8.2 ng/ml(range,2.8-14.6 ng/ml).I-125 seed implantation(D90=140-155 Gy)was performed.Serum PSA was monitored every month for the first 3 months and every 3 months for the next 20 months.Results The range of follow-up time was 3-23 months.At 1,2,3,6,9,12,15,18 and 21 months after implantation,the median serum PSA values were 6.7,5.0,2.7,1.6,1.2,0.9,0.8,0.8 and 0.7 ng/ml;and the median percentage change in ser- um PSA were 72%,51%,29%,20%,13%,11%,9%,9% and 8%,respectively.One month after brachy- therapy,30% of the patients had fluctuation in PSA.Conclusions Compared with radical prostatectomy and androgen ablation therapy,the rate of PSA decline is slower with fluctuation at early phase.The most sig- nificant decline of PSA occurs in the first 12 months,especially in the first 3 months after I-125 seed implan- tation.