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目的:探讨联合~(125)I放射性粒子植入术和间歇性内分泌治疗局部进展期前列腺癌的临床价值。方法:前列腺癌患者20例,年龄52～80岁,中位年龄74岁,PSA:6.83～643.8ng/mL,Gleason Score:7～9分,临床分期T3N0M0。连续硬膜外麻醉,截石位,直肠超声从前列腺基底到尖部进行扫描,图像传送至计算机计划系统进行三维重建和术中计划,根据计划行直肠超声引导下经会阴~(125)I放射性粒子植入术,术后结合雄激素全阻断疗法。当PSA达到0ng/mL,并稳定2个月后停止内分泌治疗,当PSA连续3次上升,则重新开始内分泌治疗。结果:所有患者手术均顺利,术中使用穿刺针26～36根,植入粒子57～99粒,平均73粒。术后随访8～51个月,平均22月。1例术后16个月发生骨转移,1例术后22个月死亡。术后3～5个月所有患者的PSA都降到正常范围,其中3例PSA未达到0ng/mL,未停药。4例术后5～26个月,出现PSA反弹,再次用药3～5个月PSA值达到13ng/mL。目前12例未出现PSA反弹,第一周期脱离治疗时间2～44个月,平均16.9个月。近期出现的并发症有轻至中度尿路刺激症30%(6/20),急性尿潴留50%(1/20),直肠刺激症和血便25%(5/20),多数患者症状随访1年后缓解。目前18例患者的PSA值在0～1.2ng/mL之间,其中17患者PSA≤0.17ng/mL。结论:对于局部晚期前列腺癌,~(125)I放射粒子植入术结合间歇性内分泌是一种安全有效的治疗方法。
Objective: To investigate the clinical value of combined 125I radioactive seed implantation and intermittent endocrine in the treatment of locally advanced prostate cancer. Methods: Twenty prostate cancer patients aged 52-80 years, with a median age of 74 years, PSA: 6.83-643.8 ng / mL, Gleason Score: 7-9, and clinical stage T3N0M0. Continuous epidural anesthesia, lithotomy position, and rectal ultrasound were performed from the base of the prostate to the tip. The images were sent to a computerized planning system for 3D reconstruction and intraoperative planning. According to the planned transrectal ultrasound guided perineal ~ (125) I radioactivity Particle implantation, postoperative combined androgen blockade therapy. Endocrine therapy was discontinued when the PSA reached 0 ng / mL and was stable for 2 months. Endocrine therapy was restarted when the PSA increased 3 times in a row. Results: All the patients underwent surgery successfully with 26-36 puncture needles and 57-99 implants with an average of 73 tablets. The patients were followed up for 8 ~ 51 months, average 22 months. One patient had bone metastases at 16 months after operation and one patient died at 22 months after operation. After 3 to 5 months, the PSA of all patients fell to the normal range, of which 3 cases of PSA did not reach 0ng / mL, did not stop. 4 cases of postoperative 5 to 26 months, PSA rebounded, again 3 to 5 months, the PSA value reached 13ng / mL. Currently 12 cases did not appear PSA rebound, the first cycle of treatment from 2 to 44 months, an average of 16.9 months. Recent complications include 30% (6/20) of mild-to-moderate urinary tract irritation, 50% (1/20) of acute urinary retention, 25% (5/20) of rectal irritation and bloody stools, and most of the patients are followed up A year later to ease. At present, the PSA values of 18 patients range from 0 to 1.2 ng / mL, of which 17 patients PSA ≤ 0.17 ng / mL. CONCLUSIONS: ~ (125) I radioactive particle implantation combined with intermittent endocrine is a safe and effective treatment for locally advanced prostate cancer.