Study Of The Clinical Application In¹²⁵I Radioactive Seed Implantation Brachytherapy For Prostate Cancer

BackgroundProstate cancer have been the most common tumor in the reproductive system of the middle-aged and old male. It was highly different that the incidence of prostate cancer happened at home and abroad, which the higher incidence in Europe and it have been the No.l in the United States that replaced the lung cancer. In contrast to the Europe and the United States, the incidence of prostate cancer in China is relatively lower. However, the prostate cancer is increasingly younger age and its incidence is obviously rising trend with the population aging, changes in diet, the improvement of diagnostic technique and the extension of people’s life in recent years.ObjectiveTo evaluate the clinically therapeutic efficacy of125I radioactive seed implantation brachytherapy for prostate cancer.MethodLA total of114patients with prostate cancer were treated with either monotherapy or combination therapy according to the clinical characteristics (pretreatment PSA, clinical stage, Gleason score,etc). All patients were final diagnosed with prostate cancer at biopsy. The patients with early localized prostate cancer that the serum PSA level was less than10ng/ml, the Gleason score was7or below, the clinical stage was T1N0M0-T2N0M0were treated with either125I radioactive seed implantation (PB group, total29cases) or radical prostatectomy (RP group, total27cases).125I implantation combined with ADT (PB+ADT group, total28cases) or androgen deprivation therapy(ADT group:bilateral orchidectomy plus anti-androgen drugs, total30cases) was performed in the patients with intermediate and advanced stage prostate cancer.2.All patients were followed up for the PSA values at3、6、12months after treatment, urinary and rectal complications, erectile function and survival rate.The range of follow-up time was3to20months(mean16.2months).3.Contrast analysis between the PB group and RP group, PB+ADT group and ADT group, such as the serum PSA level after treatments complications and survival rate was perforemed respectively. These comparable groups had very similar clinical characteristics (Gleason score, etc).Result1.PB group and RP groupAt3、6、12months after treatment, PSA levels of the two groups were2.70～8.20ng/ml(5.13±1.60ng/ml)and0.08～0.40ng/ml(0.17±0.07ng/ml),0.70～2.70ng/ml(1.64±0.56ng/ml) and0.06～0.20ng/ml(0.13±0.46ng/ml),0.02～0.40ng/ml(0.17±0.08ng/ml) and0.05～0.20ng/ml(0.13±0.05ng/ml), respectively. Each of them decreased significiantly contrast to that before the treatment (P<0.05). The patients in PB group had a lower PSA value after3and6months treatment. This difference was statistically significant(P<0.05). But there was no significant differences in the PSA level between the two groups12months later(P>0.05). On the side effects such as urinary and rectal symptoms,21patients treated with PB were found having urinary, rectal complications at gradeⅠ、Ⅱ and erectile problems, and23patients in RP group were found having the similar problems. But statistically significant difference(P<0.05)was observed between the two groups in that the problems in the latter group were more serious and a patient with rectal fistula disease in the group were even found. Patients underwent125Ⅰ seeds implantation as a sole treatment were all survival during the follow-up period and only one patient died after radical prostatectomy. This difference was not statistically significant(P>0.05). 2.PB+ADT group and ADT groupAt3、6、12months after treatment, PSA levels of the two groups were2.70～18.10ng/ml(7.16±3.37ng/ml)and1.60～8.20ng/ml(4.29±1.83ng/ml),1.10～3.70ng/ml(2.03±0.68ng/ml)and1.30～5.30ng/ml(2.84±1.13ng/ml),0.08～1.90ng/ml(0.94±0.43ng/ml)and0.90～4.30ng/ml(2.24±1.01ng/ml), respectively. Each of them decreased significiantly contrast to that before the treatment(P<0.05). And more significant differences were seen in PSA where ADT group had a worse level than PB+ADT group(P<0.05). No significant differences between patients treated with PB+ADT or ADT were detected with regard to the complications after treatment(P>0.05). For both treatment groups, urinary and rectal complications、erectile dysfunction were seen(PB+ADT group:26cases; ADT group:28cases). Two patients died from distant metastatic in PB+ADT group and overall survival rate was92.9%. It was higher than that in ADT group where10patients died. This difference was statistically significant(P<0.05).Conclusion1.125I radioactive seed implantation monotherapy is as effective as radical prostatectomy for the patients with early localized prostate cancer. Furthermore, it causes less and light complications compared with radical prostatectomy.2.125I radioactive seed implantation combined with androgen deprivation therapy and androgen deprivation monotherapy are both effective for patients with intermediate and advanced stage prostate cancer. The former can achieve better biochemical control and a higher survival rate.