Urinary morbidity after 125I brachytherapy of the prostate

OBJECTIVE: To assess urinary morbidity within the first 6 months after transperineal prostate brachytherapy (TPBT) with 125I for localized prostate adenocarcinoma. PATIENTS AND METHODS: Between September 2000 and July 2001, 50 consecutive patients with favourable early-stage prostate cancer were treated with TPBT. Clinical and objective investigations, including uroflowmetry and postvoid residual urine measurements, were evaluated for short-term urinary morbidity; predictive factors were also sought. RESULTS: Thirty-eight (76%) patients developed urinary disorders, but severe urinary complications were exceptional. The International Prostate Symptom Score (IPSS) changed significantly during the first and third month after implantation and then improved during the sixth month. Concomitantly, the maximum and the average urinary flow rate deteriorated significantly. The variations in postvoid residual were less significant. An initial IPSS of > 8 and previous alpha-blocker treatment were identified as significant predictive factors of urinary morbidity, as were the TPBT dose received by 90% of the target volume and by 30% of the urethra, and the volume of prostate receiving 144 Gy. CONCLUSION: Urinary morbidity after TPBT is frequent but rarely exceptionally severe; patients must therefore be given full information. Patients with a higher initial IPSS or having had previous alpha-blocker treatment, with their associated dosimetric factors, are at greater risk of these urinary morbidity.     

前列腺癌125I放射粒子植入术后直肠并发症及防治

目的探讨前列腺癌^125Ⅰ粒子植入术后直肠并发症及防治。方法2001年11月～2006年6月，在直肠超声引导下，经会阴前列腺^125Ⅰ放射粒子植入联合雄激素全阻断治疗中晚期前列腺癌90例，术后每1～3个月随访，观察直肠并发症及治疗。结果89例随访1～55个月，平均22个月。直肠并发症Ⅰ、Ⅱ、Ⅲ、Ⅳ级发生率分别为11．2％（10／89）、6．7％（6／89）、0％及2．2％（2／89）。Ⅰ、Ⅱ级16例观察及对症治疗，半年后症状逐渐减轻。Ⅳ级2例，1例因直肠炎在外院行多次检查和治疗，1例合并重度糖尿病，采用结肠腹壁造口，结合膀胱穿刺造瘘治疗，病情好转。结论^125Ⅰ放射粒子植入术后发生放射性直肠炎，一般采用观察及对症治疗，病情有自限性，不要盲目过度检查及治疗，对合并糖尿病者应积极治疗，以减少尿道直肠瘘的发生。     

125I放射性粒子植入治疗C期激素难治性前列腺癌

目的 探讨125 I放射性粒子植入治疗C期激素难治性前列腺癌的临床疗效.方法 本组11例,均通过前列腺穿刺活检确诊为前列腺癌,Gleason评分6～9分,经内分泌治疗后确认进展为激素难治性前列腺癌时平均PSA为10.91ng/ml,临床分期均为C期,行直肠B超引导下,经会阴穿刺植入放射性125 I粒子治疗.结果 全组患者手术顺利,手术时间30～70min,平均植入粒子49粒,均于术后3～6d出院.术后随访3～71个月,平均31个月.完全有效3例,部分有效1例,病情稳定3例,无效3例,失访1例,PSA无进展生存率70%(7/10).无效患者3例中,2例PSA无进展生存期达2年以上,所有患者术后均未出现严重并发症.结论 125 I放射性粒子植入治疗C期激素难治性前列腺癌安全、有效.     

Sudden death after 125I brachytherapy in prostate cancer patient: a case report

A management of 125I isotope is defined by medical guideline from Ministry of Health, Labour and Welfare in Japan. According to this, when the patient died within one year after 125I interstitial permanent prostate brachytherapy, we have to do autopsy and collect all implanted isotopes as soon as possible. We report here, a 70-year-old man who underwent 125I interstitial permanent prostate brachytherapy for localized prostate cancer and one month after brachytherapy the patient died of acute cerebral hemorrhage, which was unrelated to the 125I brachytherapy. Autopsy was performed and collection of migrated isotopes was extremely difficult in technically. In addition, the cost of autopsy and distance from our hospital were also problems in this case. Treatment of prostate cancer with brachytherapy has increased in Japan, and we should establish management manual for sudden death case after 125I brachytherapy.     

125I粒子植入治疗前列腺癌122例临床分析

目的 探讨125 I粒子植入在前列腺癌治疗中的临床应用价值.方法 122例前列腺癌患者行粒子植入,经直肠 B 超引导,计算机确定治疗计划,经会阴穿刺植入前列腺125I放射粒子.结果 全组手术顺利,平均植入125 I放射粒子46 粒,平均手术时间 68 min,术后平均住院时间6.5 d.术后完整随访资料102 例,随访...     

Biochemical (prostate-specific antigen) relapse-free survival and toxicity after 125I low-dose-rate prostate brachytherapy

OBJECTIVE: To report our clinical experience and 5-year prostate-specific antigen (PSA) relapse-free survival rate for early-stage prostate cancer after (125)I low-dose-rate prostate brachytherapy. PATIENTS AND METHODS: In all, 300 patients were treated between March 1999 and April 2003, and followed prospectively. Patients were stratified into low-, intermediate- and high-risk groups, and those receiving neoadjuvant androgen deprivation (NAAD) or not. Kaplan-Meier estimates of PSA relapse-free survival and PSA nadirs were obtained for all patients and for the risk groups. Toxicity, as urinary and erectile dysfunction (ED), were reported from a prospective database. RESULTS: The median (range) follow-up was 45 (33-82) months. The actuarial PSA relapse-free survival was 93% at 5 years; 21 (7%) of patients had evidence of biochemical failure as defined by the American Society of Therapeutic Radiation Oncology criteria. There was no significant difference in actuarial survival for patients in the different risk groups, or between those receiving NAAD or not (low-risk 96%, intermediate 89%, high 93%, P = 0.12; NAAD 92%, no NAAD 95%, P = 0.30). Overall the 3-year median PSA level was 0.3 ng/mL (192 men). There was no significant difference in median 3-year PSA levels for different risk groups, or for those treated with or with no NAAD. The 3- and 4-year PSA nadir of <0.5 ng/mL was achieved by 71% and 86% of men, respectively. The acute urinary retention rate was 7%; 5.6% of men developed urethral strictures requiring dilatation, while 2.7% required a transurethral resection of the prostate after implantation, for obstructive symptoms. Of patients with no ED before treatment, 62% had no ED at 2 years, and of these 60% used a phosphodiesterase inhibitor. CONCLUSION: This prospective series confirms the excellent overall biochemical survival after (125)I brachytherapy; the treatment was tolerated well, with early and late urinary toxicity and ED similar to other published results.     

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。     

125Ⅰ放射粒子植入治疗激素难治性前列腺癌

目的　探讨12 5I放射粒子植入治疗激素难治性前列腺癌的临床价值。　方法　直肠B超引导下 ,经会阴穿刺前列腺12 5I放射粒子植入治疗激素难治性前列腺癌 15例 ,其中 5例合并骨转移者同时行转移灶外放疗。　结果　 15例手术顺利 ,平均植入12 5I放射粒子 5 6粒 ,平均手术时间 70min ,平均住院时间 5d。术后随访 5～ 2 8个月 ,平均 11个月 ,完全反应 5例 ,部分反应 4例 ,病情稳定 3例 ,病情恶化 3例 ,PSA无进展生存率 80 % ( 12 /15 ) ,未发生严重并发症。　结论　12 5I放射粒子植入治疗激素难治性前列腺癌安全、微创、并发症发生率低 ,疗效肯定。     

单纯125I放射性粒子植入治疗早期前列腺癌的临床分析

目的 探讨单纯125I放射性粒子植入治疗早期前列腺癌的临床疗效. 方法 2007年1月至2011年7月前列腺癌患者18例,年龄60 ～ 81岁,平均74岁.术前PSA 0.38 ～ 8.73 μg/L,平均5.09 μg/L.均经前列腺穿刺病理诊断为前列腺癌,Gleason评分5～6分,临床分期T1c～T2a.采用直肠B超引导下经会阴植入125I粒子治疗. 结果 本组手术顺利,手术时间37～52 min,平均植入粒子54粒,术后住院时间3～4d.随访时间3～57个月,平均15个月,1例失访.随访17例血PSA无进展生存率为100％ (17/17),7例随访超过18个月,血PSA水平长期低于0.20 μg/L,其中3例波动于0 ～0.08 μg/L,3例波动于0.02 ～0.12 μg/L,1例波动于0.12 ～ 0.20 μg/L.17例均未出现严重并发症. 结论 单纯125I放射性粒子植入治疗早期前列腺癌安全、有效.     

Prostate-specific antigen kinetics after I125-brachytherapy for prostate adenocarcinoma

Purpose

To investigate a potential correlation between the achievement of a cut-off of nadir PSA (nPSA) after brachytherapy (BRT) with biochemical Disease-Free Survival (bDFS) and to define the rate of post-BRT PSA bounces.

Methods

Retrospective analysis was carried out in 105 consecutive patients affected with early-stage prostate adenocarcinoma who underwent ¹²⁵I BRT. Only patients with a minimum follow-up ≥24 months were included. Biochemical DFS was chosen as primary endpoint.

Results

At a median follow-up of 51.2 months, 3- and 5-year bDFS were 96.8 and 91.2 %, respectively. Median time to biochemical failure (BF) was 54 months. By Kaplan–Meier analysis, patients achieving nPSA ≤ 0.35 ng/mL had significantly higher bDFS (3- and 5-year bDFS: 100 and 98.5 % vs 83.3 and 66.7 %, respectively; p = 0.001). Bounce PSA occurred in 28.6 % of patients, at a median time of 21.5 months. No BFs were observed in the bounce group. Achieving a nPSA ≤ 0.35 ng/mL was the only factor independently associated with long-term bDFS on both univariate (p = 0.000) and multivariate analysis (HR 3.82; p = 0.003).

Conclusions

Patients attaining a nPSA ≤ 0.35 ng/mL are significantly more likely to experience long-term freedom-from-biochemical failure. Bounce PSA occurs in approximately 30 % of patients. Time to onset of PSA increase seems the most reliable feature to distinguish bounce from failure. Tailored follow-up strategies are needed for patients at higher risk of recurrence, and caution is advised in interpreting an early increase in PSA levels in the first 24–30 months after BRT.