Long-term potency preservation following brachytherapy for prostate cancer.
BJU INTERNATIONAL(2012)
摘要
OBJECTIVES To assess potency preservation in men following brachytherapy for prostate cancer with or without external beam radiation therapy (EBRT) and/or androgen deprivation therapy (ADT). To evaluate the factors that significantly impact this rate. PATIENTS AND METHODS In all, 1063 potent men with T1-T3 prostate cancer were treated from 1990 to 2007 with seed implantation alone (Pd-103 or I-125) (69.6%) or combined modality treatment consisting of a partial dose 103Pd implant followed 6-8 weeks later by EBRT (45 Gy, prostate/seminal vesicles only) (30.4%). ADT was used in 49.1% of cases (range 1-27 months). Patients were required to have a minimum of 2 years follow-up and to be off ADT for a minimum of 1 year. Erectile function was assessed prior to seed implantation and at each follow-up visit using the physician-assigned Mount Sinai Erectile Function Score (MSEFS): 0, unable to have erections; 1, erections insufficient for intercourse; 2, suboptimal erections but sufficient for intercourse; 3, normal erectile function. Potent was defined as a score of greater than or equal to 2 with or without use of a phosphodiesterase type 5 inhibitor. The potency rate was calculated using actuarial methods with comparisons tested by log-rank and Cox regression analysis. RESULTS The 5-year and 10-year actuarial rate of potency preservation was 68.0% and 57.9%, respectively, at last follow-up. On multivariate analysis, 5- and 10-year potency was 87.6% (79.5%) for men younger than 60, 68.0% (57.5%) for age 60-70, and 42.2% (31.0%) for men older than 70 (P < 0.001). Pretreatment MSEFS of 2 had a potency rate of 51.7% (37.2%) vs 74.2% (65.2%) for an MSEFS of 3 (P < 0.001). There was a 75.8% (62.6%) potency rate without ADT vs 60.0% (53.0%) with ADT (P < 0.001). Five-year potency was 76.4% for implant alone, 71.0% for implant with EBRT, 62.2% for implant with ADT, and 57.9% for implant with EBRT and ADT (P < 0.001). CONCLUSION Increasing initial age at implant, diminished pretreatment erectile function and the use of combination therapy with EBRT and/or ADT significantly increases erectile dysfunction following brachytherapy.
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关键词
prostate cancer,brachytherapy,potency,androgen deprivation
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