125I放射粒子植入治疗前列腺癌12例临床分析

目的探讨前列腺125I放射粒子植入内放疗在前列腺癌治疗中的意义。方法依据治疗计划,在直肠B超引导下,经会阴穿刺植入前列腺125I放射粒子对12例前列腺癌行三维适形内放疗。结果全组手术顺利,平均植入125I放射粒子58粒,平均手术时间80min,术后平均住院时间7．2d。随访12例术后3个月结果：平均PSA由19．8ng／mL降至0．74ng／mL;随访6例术后6个月结果：5例PSA进一步降低,平均降至0．11ng／mL;1例升高,由0．51ng／mL升高至1．65ng／mL;无1例出现严重的并发症。结论采用永久性放射粒子植入前列腺、三维适形内放疗是一种有效、微创的治疗前列腺癌的方法。     

Neoadjuvant hormonal therapy for low‐risk prostate cancer induces biochemical recurrence after radical prostatectomy via increased lymphangiogenesis‐related parameters

Background

The effects of neoadjuvant hormonal therapy (NHT) on pathological features and lymphangiogenesis in patients with prostate cancer (PCa) for each pre‐operative risk classification are unclear.

Methods

To clarify the anti‐cancer effects of NHT, we investigated 153 patients (non‐NHT group = 80 and NHT group = 73) who underwent radical prostatectomy (RP) in Nagasaki University Hospital. Lymph vessel density and area (evaluated by D2‐40‐positive vessels), vascular endothelial growth factor (VEGF)‐C and VEGF‐D expressions, and biochemical recurrence (BCR)‐free survival were compared between these two groups for each D'Amico risk classification (low = 33, intermediate = 58, high = 62 patients).

Results

In low‐risk PCa patients, the risks of lymph vessel invasion and BCR were significantly higher in the NHT group than in the non‐NHT group (P = 0.040 and 0.022, respectively). Such significant difference was not seen in the intermediate‐ or high‐risk PCa groups. Lymph vessel density of the peri‐tumoral and intra‐tumoral areas and the lymph vessel area were significantly higher (P < 0.001) in the NHT group than in the non‐NHT group in low‐risk PCa. In regard to the expression of VEGF‐C or VEGF‐D, significant difference was not detected in low‐risk PCa.

Conclusions

NHT stimulated cancer cell progression and BCR via up‐regulation of lymphangiogenesis‐related parameters in patients with low‐risk PCa. Although VEGF‐C and VEGF‐D expressions were not changed by NHT, lymph vessel density and area were increased in low‐risk PCa patients. We suggest that NHT for patients with low‐risk PCa may have a high risk for BCR after RP.     

Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent 125iodine implants

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To report our analysis of the oncological outcome, side‐effects and complications after ¹²⁵I‐brachytherapy, based on 10 years of experience, as low dose‐rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer.

PATIENTS AND METHODS

Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow‐up of ≥30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3–4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the ‘Phoenix consensus’.

RESULTS

The median follow‐up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10‐year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low‐, intermediate‐ and high‐risk groups. Multivariate Cox regression analyses identified Gleason score and prostate‐specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of ≤6, 7 and >7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of ≤10, 10.1–20 and >20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy.

CONCLUSIONS

The excellent long‐term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ‐confined prostate cancer.     

新辅助治疗的优势:机器人辅助腹腔镜下前列腺癌根治术治疗局部进展期前列腺癌

目的探讨术前新辅助内分泌治疗(NHT)是否能使接受机器人辅助腹腔镜前列腺癌根治术(RLRP)治疗的局部进展期前列腺癌患者临床获益。方法回顾性研究中国医科大学附属第一医院泌尿外科自2018年5月至2019年8月根治术前通过穿刺活检及MRI诊断为局部进展期前列腺癌患者31例。其中术前行新辅助内分泌治疗12例,年龄(65.67±5.123)岁,未经内分泌治疗19例,年龄(66.58±8.520)岁。比较两组患者手术时间、术中出血量、术后住院时间、术后切缘阳性率、淋巴结阳性率、术后吻合口漏尿等情况。结果 31例手术均无中转开放及二次手术。新辅助治疗组手术时间[(176.84±54.875)min vs.(66.58±8.520)min,P=0.032]和术后住院时间[(9.50±2.505)min vs.(13.87±5.987)min,P=0.048]缩短,术中失血量[(165.68±79.746)mL vs.(13.87±5.987)mL,P=0.013]减少。治疗组肿瘤切缘阳性率(8.33%vs.26.32%,P=0.001)和清扫淋巴结阳性率(17.14%vs.38.18%,P=0.037)也明显低于对照组。术前辅助内分泌治疗并不能降低术后Gleason评分和临床分期(P>0.05)。结论术前新辅助内分泌治疗在RLRP治疗局部进展期前列腺癌患者中可能在一定程度上降低手术难度并且减少术中出血,使患者受益。     

Prostate-specific antigen relapse-free survival in patients with localized prostate cancer treated by brachytherapy

OBJECTIVE: To report the clinical outcome after permanent implantation of (125)iodine seeds (brachytherapy) for early prostate cancer, after 8.2 years of follow-up. PATIENTS AND METHODS: Between March 1995 and December 2001, 667 men (mean age 63 years, range 42-77) were treated with brachytherapy at the one cancer centre; 346 (51.9%) had a short course of neoadjuvant hormone therapy. The prescribed minimum peripheral dose was 145 Gy. No patient received external beam radiation. RESULTS: The median (range) follow-up was 31 (18-98.2) months; 41 patients were lost to follow-up. The actuarial biochemical relapse-free survival was 74.9%; 100 patients had biochemical relapse (international definition). In all, 20 patients had clinical relapse, and 24 died (10 from prostate cancer). The prostate-specific antigen (PSA) relapse-free survival was 78.3%, 66.5% and 56.4% for patients with Gleason scores of <7, 7 and > 7, respectively, and was 81.4%, 69.8% and 36.3% for those with PSA levels of <10, 10-20 and > 20 ng/mL, respectively (both P < 0.001). There was a strong cohort effect depending on year of implant, with progressive annual improvements in relapse-free survival (P < 0.001). Hormone therapy, tumour stage, prostate volume before implantation, age and D90 dose had no significant effect on the outcome. CONCLUSION: The overall relapse-free survival for all patients was 75%; the initial PSA, Gleason score and risk group were significant factors predicting the outcome. Increasing clinical experience was associated with a better outcome but neoadjuvant hormone therapy had no effect.     

Transperineal interstitial permanent prostate brachytherapy for Japanese prostate cancer patients in Hawaii

BACKGROUND: Our aim was to report clinical and biochemical outcomes of transperineal interstitial permanent prostate brachytherapy in the treatment of Japanese patients with clinically organ-confined prostate cancer in Hawaii. METHODS: Ninety-five Japanese patients underwent transperineal interstitial permanent prostate brachytherapy using either iodine-125 or palladium-103 for clinical T1c-T2b N0 M0 prostate cancer. These procedures were carried out between December 1998 and December 2002 at The Queen's Medical Center in Honolulu, Hawaii. Prostate-specific antigen measurements were collected from all patients at follow up. Biochemical failure was defined by three consecutive rises in prostate-specific antigen levels, based on the criteria of the American Society for Therapeutic Radiology and Oncology Consensus panel. RESULTS: The median patient age was 71 years (range, 46-87 years). Thirty-six patients were implanted with either iodine-125 or palladium-103 as monotherapy; 59 patients received moderate-dose external beam irradiation first, followed by a prostate brachytherapy boost. The median follow-up length, calculated from the day of implantation, was 801 days (range, 237-1421 days). During this follow-up period, The Kaplan-Meier estimate of freedom from biochemical failure in this series was 94%. No major complications were observed. CONCLUSIONS: Clinical and biochemical outcomes in the treatment of Japanese patients in Hawaii suffering from localized prostate cancer, using transperineal interstitial permanent prostate brachytherapy, with or without external beam irradiation, compared favorably to results in similarly treated patients in the general US population.     

晚期前列腺癌内分泌治疗后血清PSA、f-PSA含量的变化

目的探讨前列腺癌(PCa)患内分泌治疗后前列腺特异抗原(PSA)、游离前列腺特异抗原与总前列腺特异抗原比值(f／tPSA)变化的临床意义。方珐测定PCa患内分泌治疗前及治疗后1、3、6个月血清PSA、游离前列腺特异抗原(f-PSA)变化。砖杲治疗后1个月与治疗前相比血清PSA下降明显，治疗后6个月较治疗后1个月血清PSA下降亦有显意义；治疗后患血清f-PSA水平明显下降。f／tPSA值的变化无显意义。结论血清PSA、f-PSA可作为判断PCa内分泌治疗效果的标准．如血清PSA、f-PSA复又升高提示肿瘤复发。     

Early quality of life outcomes in patients with prostate cancer managed by high‐dose‐rate brachytherapy as monotherapy

Objectives: To evaluate the early quality of life outcomes in prostate cancer patients managed by high‐dose‐rate brachytherapy as monotherapy. Methods: A total of 51 patients with cT1c–T3aN0M0 prostate cancer treated between July 2007 and January 2010 were included in this study. The average age was 69 years, and the average initial serum prostate‐specific antigen was 10.98 ng/mL. A total of 25, 18 and eight patients were considered to be low, intermediate and high risk, respectively. All patients received one implant of Ir‐192 and seven fractions of 6.5 Gy within 3.5 days for a total prescribed dose of 45.5 Gy. For high‐risk prostate cancer, neoadjuvant androgen deprivation therapy was carried out for at least 6 months, and continued after high‐dose‐rate brachytherapy. Quality of life outcomes were measured by using the International Prostate Symptom Score, the Functional Assessment of Cancer Therapy‐Prostate and the International Index of Erectile Function Questionnaire. The oncological outcome was assessed by serum prostate‐specific antigen and diagnostic imaging. Adverse events were also recorded. Results: The Functional Assessment of Cancer Therapy‐Prostate scores decreased for a few months after high‐dose‐rate brachytherapy, and recovered to pretreatment condition thereafter. The International Prostate Symptom Score significantly increased 2 weeks after treatment for each of its items and their sum, and it returned to baseline after 12 weeks. Sexual function decreased at 2 and 4 weeks, and recovered after 12 weeks. Severe complications were rare. Within a median follow up of 17.2 months, two patients showed a prostate‐specific antigen recurrence. Conclusions: High‐dose‐rate brachytherapy for prostate cancer is a feasible treatment modality with acceptable toxicity and only a limited impact on the quality of life.