局部中危前列腺癌近距离照射治疗联合最大限度雄激素阻断疗效分析

Analysis of permanent brachytherapy combined with maximal androgen blockade in local intermediated-risk prostate cancer

目的 分析局部中危前列腺癌患者接受近距离照射联合最大限度雄激素阻断治疗的疗效及并发症.方法 2003年12月至2009年12月北京协和医院泌尿外科共对307例局限性前列腺癌患者进行近距离照射治疗,其中资料完整并随访满5年的中危患者98例.患者年龄58 ～ 84岁,平均74岁.术前前列腺特异抗原（PSA）为0.4～ 19.0 μg/L,平均11.2 μg/L.临床分期T1 cN0M0～T2bN0M0.术前Gleason评分4～7分,平均6.7分.前列腺体积14 ～ 65 ml,平均32.1 ml.所有98例患者均接受前列腺癌近距离照射治疗＋最大限度雄激素阻断治疗.术后随访5年截止,观察生化复发率、无生化复发生存率、肿瘤特异性生存率、总生存率、补救性治疗方式及效果、不良反应发生率.结果 随访期间出现生化复发19例,中位复发时间36个月.死亡7例,其中1例45个月后死于前列腺癌复发转移,6例死于其他非相关疾病.术后5年无生化复发率为80.6％,总生存率92.9％,肿瘤特异性生存率98.9％,无生化复发生存率79.3％.术后下尿路及直肠刺激症状发生率76.5％,尿潴留7例（7.1％）,放置尿管l周后全部恢复正常排尿.单个粒子移位2例.未发生直肠穿孔等严重并发症.结论 近距离照射联合最大限度雄激素阻断治疗局限性中危前列腺癌疗效肯定、创伤小,术后不良反应少.

Objective To evaluate the outcomes of permanent brachytherapy combined with maximal androgen blockade（MAB） in local intermediated-risk prostate cancer.Methods From December 2003 to December 2009,307 patients of local prostate cancer were treated with brachytherapy,98 cases of intermediated-risk were followed-up for 5 years and data were recorded,aged from 58 to 84 years,average 74 years.Serum PSA was 0.4-19.0 μg/L,average 11.2 μg/L,clinical TNM stage was TlcN0M0-T2bN0M0.Gleason score 4-7,6.7 in average.Prostate volume ranged from 14 to 65 ml,average 32.1 ml.All the 98 patients underwent permanent brachytherapy combined with MAB.Biochemical recurrence rate,biochemical-free survival,tumor-specific survival,overall survival,salvage therapy and complications were analyzed.Results Followed up for 5 years,19 cases had biochemical recurrence,median recurrence period：36 months.One patient died of prostate cancer 45 months after brachytherapy of all 7 patients died in 5 years.Five-years biochemical-free recurrence rate：80.6%,overall survival：92.9%,tumor-specific survival：98.9%,biochemical-free survival：79.3%.Low-urinary tract and rectal irritation symptoms occurred in 75 cases （76.5%）.Urinary retention occurred in 7 cases （7.1%） with catheterization duration less than 1 week,no surgical operation were performed.Seeds immigration to lung in 2 cases.No serious complications occurred.Conclusion In local intermediated-risk prostate cancer patients,permanent brachytherapy combined with short-term MAB can be an effective treatment with few complications.