I-125放射性粒子植入治疗T1-T2前列腺癌后的PSA动力学。

C M Iannuzzi, R G Stock, N N Stone
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引用次数: 23

摘要

尽管人们对前列腺近距离放射治疗有了新的兴趣,但关于该手术对前列腺特异性抗原(PSA)随时间变化的影响的信息很少。本研究描述了碘-125 (I-125)经直肠超声引导下经会阴前列腺植入后的PSA动力学。从1991年2月到1997年9月,207例患者接受了I-125前列腺植入治疗T1-T2前列腺癌。在治疗前和治疗后1-73个月(中位24个月)获得PSA值。前列腺植入后PSA的变化作为预处理PSA的一部分(随访时的PSA /预处理时的PSA)进行测量。PSA失败定义为两次PSA升高或PSA > 1 ng/ml。155名患者在1个月的时间内记录了PSA值。27%(42/155)患者的PSA值大于1个月前的PSA值。这对未来PSA失败没有显著影响。所有患者植入后PSA的中位百分比变化如下:1个月,0.73;3个月,0.30;6个月,0.18;12个月,0.12;18个月,0.12;24个月,0.08;30个月,0.07;36个月,0.08;42个月,0.08;48个月,0.05。最显著的下降发生在前12个月。随后在12-24个月之间逐渐下降。24个月后PSA值变化不大。1年PSA值对PSA失败有显著影响。1年PSA为1 ng/ml的患者(69例)(P = 0.002)。27例患者出现PSA功能衰竭。PSA失败的时间从12-48个月不等(中位数为24个月),但大多数(20/27)失败发生在18个月后。我们得出结论,前列腺I-125植入后的PSA下降幅度最大,发生在第一年,2年后变化不大。1年PSA值> 1 ng/ml可高度预测最终的PSA失效,这在大多数患者治疗后18个月发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PSA kinetics following I-125 radioactive seed implantation in the treatment of T1-T2 prostate cancer.

Although there is renewed interest in prostate brachytherapy, little information is available on the effect of the procedure on prostate-specific antigen (PSA) changes over time. This study describes PSA kinetics after iodine-125 (I-125) transrectal ultrasound-guided transperineal implantation of the prostate. From February 1991-September 1997, 207 patients were treated with an I-125 prostate implant alone for T1-T2 prostate cancer. PSA values were obtained prior to treatment and at 1-73 months (median, 24 months). The change in PSA after implantation of the prostate was measured as a fraction of the pretreatment PSA (PSA at follow-up/pretreatment PSA). PSA failure was defined as two elevations in PSA or PSA > 1 ng/ml. One hundred fifty-five patients had PSA values recorded at the 1-month time period. A PSA value greater than the pretreatment PSA at 1 month was found in 27% (42/155). This had no significant effect on future PSA failure. The median percentage change in PSA after implantation for all patients were as follows: 1 month, 0.73; 3 months, 0.30; 6 months, 0.18; 12 months, 0.12; 18 months, 0.12; 24 months, 0.08; 30 months, 0.07; 36 months, 0.08; 42 months, 0.08; and 48 months, 0.05. The most significant decline occurred in the first 12 months. This was followed by a more gradual decline between 12-24 months. There was little change in PSA values after 24 months. The 1-year PSA value had a significant effect on PSA failure. Patients with a 1-year PSA <1 ng/ml (66) had an actuarial 4-year freedom-from-failure rate of 90%, compared to a rate of 62% for those with values >1 ng/ml (69) (P = 0.002). Twenty-seven patients developed PSA failure. The time to PSA failure ranged from 12-48 months (median, 24 months), but most (20/27) failures occurred after 18 months. We conclude that the greatest decline in PSA after I-125 implantation of the prostate occurs during the first year, and little change occurs after 2 years. A 1-year PSA value > 1 ng/ml is highly predictive of eventual PSA failure, which occurs in most patients after 18 months posttreatment.

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