125I 放射性粒子植入术联合间歇性内分泌疗法治疗局部中高危前列腺癌

目的 探讨¹²⁵I放射性粒子植入术联合间歇性内分泌疗法治疗局部中高危前列腺癌的临床价值。方法 前列腺癌患者25例，年龄 64～85 岁，平均年龄75岁，前列腺特异性抗原（PSA）：10.3～354.8 ng/mL，Gleason 评分：7～9 分，临床分期T2～T3N0M0。椎管内麻醉，截石位，直肠超声从前列腺基底到尖部进行扫描，图像传送至计算机计划系统进行三维重建和术中计划，根据计划行直肠超声引导下经会阴¹²⁵I放射性粒子植入术，术后联合全部雄激素阻断疗法。当PSA达到0 ng/mL，并稳定2个月后停止内分泌治疗，当PSA连续3次上升，则重新开始内分泌治疗。结果所有患者手术均顺利，植入粒子85～110粒，平均93粒。术后随访8～20个月，平均12个月。术后3～6个月所有患者的PSA都降到正常范围，其中10例患者PSA未达到0 ng/mL，未停药。5例患者术后5～16个月，出现PSA反弹，再次用药3～5个月PSA值达到0 ng/mL。2例患者转变为激素非依赖性并出现骨转移。目前17例患者的PSA值在0～1.2 ng/mL之间，其中10患者PSA< 0.2 ng/mL。近期出现的并发症有轻至中度尿路刺激征24%（6/25），急性尿潴留8%（2/25），直肠刺激征和血便16%（4/25），多数患者症状随访1年后缓解。结论 对于局部晚期中高危前列腺癌，¹²⁵I放射粒子植入术联合间歇性内分泌疗法是一种安全有效的治疗方法。

Clinical efficacy of combined 125I brachytherapy and intermittent androgen deprivation for locally mediate-high risk prostate cancer

Objective  To evaluate the clinical efficacy of combined  ¹²⁵I brachytherapy and intermittent androgen deprivation for locally mediate-high risk prostate cancer.Methods  A total of 25 patients with prostate cancer ranging from 64 to 85 years old (average age of 75) were recruited. The PSA level of these patients was 10.3～354.8 ng/mL, and the Gleason score was 7～9. All patients were clinically staged as T2～T3N0M0. Under continual epidural anesthesia in the lithotomy position, these patients underwent transrectal ultrasound scans from the basement of the prostate to the apex. Pictures were transmitted to the computer system to undergo three-dimensional reconstruction of the prostate and intra-operational planning. According to the plan, patients received  ¹²⁵I brachytherapy under the guidance of the transrectal ultrasound. All patients underwent maximal androgen blockage (MAB) therapy after surgery. Treatment was stopped when PSA fell to 0 ng/mL and stabilized for 2 months. The criterion for the resumption of hormonal therapy was a continuously increasing PSA level as detected in 3 consecutive tests. Results  All 25 patients completed the surgery without complications. The number of implanted seeds was 85～110, with an average of 93. The follow-up period was 8～20 months, with an average of 12 months. One case was diagnosed with bone metastasis 10 months after the surgery. Within the 3 to 6 months after surgery, all the PSA levels fell below the normal level. Ten cases did not reach 0 ng/mL, so they continued the hormonal therapy. Five cases had increasing PSA levels 5～16 months after surgery, so MAB was restarted. After that, the PSA levels decreased to 0 ng/mL within 3～6 months. Two cases changed into hormone independent prostate cancer and bone metastasis occurred in these patients. At the end of the follow up period, the remaining 17 patients' PSA level was 0～1.2 ng/mL, and 10 patients of them had a PSA level less than 0.2 ng/mL.  Early complications included mild to moderate urethral irritation (24%, 6/25), acute urine retention (8%, 2/25) and rectal irritation or bloody stool (16%, 4/25). Conclusions  The combination of intermittent androgen deprivation and  ¹²⁵I brachytherapy is an effective and safe treatment for locally advanced prostate cancer.