前列腺癌患者粒子植入治疗后血清PSA变化的观察

Changes in serum PSA after brachytherapy for prostate cancer

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：T_(1c)N_0M_0 8例,T_(2a)N_0M_0 5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^(125)I粒子植入治疗,治疗剂量D_(90)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。

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 T1cNo M0 in 8 cases, and T2aN0M0 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 serum PSA were 72% ,51% ,29% ,20% ,13% ,11% ,9% ,9% and 8% ,respectively. One month after brachytherapy,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 significant decline of PSA occurs in the first 12 months,especially in the first 3 months after I-125 seed implantation.