Abstract
Background: The treatment for moderate-risk prostate cancer patients include several methods. There are radical prostatectomy, radiotherapy, brachytherapy, cryotherapy, hormone therapy, and dynamic observation. Purpose: The goal of our study was to analyze the results of brachytherapy using I-125 in patients with moderate-risk prostate cancer. Materials and methods: Eighty six patients at the age of 48 to 76 (median 66 years) were included in the analysis. Implantation of iodine-125 sources was performed in all patients. The total dose to the prostate was 145 Gy. PSA monitoring after surgery was performed every 3 months during the first year, then every 6 months for the next 3 years, and then – annually. Survival was estimated using the Kaplan – Meier scale considering such factors as age, the D90 to the prostate, the V100 prostate, preoperative anti-androgen therapy. Quality of life analysis was made using standard IPSS questionnaire. Results: 5‑year results with median follow-up of 60 months without PSA-recurrent, tumor-specific and overall survival were 90.5%, 100% and 95.2%, respectively. The treatment method has an acceptable spectrum of complications. 1st degree urethritis in the category of RTOG within 1 month after the operation developed in 60 (69.3%) patients while in the 6‑month follow-up period the symptoms of dysuria had only 11 (13.3%) patients, which was associated with chronic urinary infection, resistant to antibiotic therapy. 1st degree radiation proctitis within 1 month after the operation developed in 2 (2.1%) patients, and after 6‑month observation period the symptoms of proctitis ceased in all patients. Before the treatment, the number of points on the IPSS scale was 0–7 points – n = 63 (74%), 8–19 points – n = 23 (26%) (median IPSS 5.7). A month later, the number of patients with mild symptomatology increased to 69.3%, 6 months after the end of treatment, the mean IPSS was 10 points. After 12 months, 0–7 points were recorded in 94% of patients. Conclusion: The permanent brachytherapy with I-125 in patients with moderate-risk prognosis showed very good functional and oncological outcomes. This method provides excellent control of the PSA level with median follow-up of 65 months, and at the same time provides high quality of urination for 2–3 years after treatment.
Highlights
The treatment for moderate-risk prostate cancer patients include several methods
The goal of our study was to analyze the results of brachytherapy using I-125 in patients with moderate-risk prostate cancer
The treatment method has an acceptable spectrum of complications. 1st degree urethritis in the category of RTOG within 1 month after the operation developed in 60 (69.3 %) patients while in the 6‐month follow-up period the symptoms of dysuria had only 11 (13.3 %) patients, which was associated with chronic urinary infection, resistant to antibiotic therapy. 1st degree radiation proctitis within 1 month after the operation developed in 2 (2.1 %) patients, and after 6‐month observation period the symptoms of proctitis ceased in all patients
Summary
Глисона ≤ 6; к группе умеренного риска – пациенты с ПСА от 10 до 20 нг / мл, индексом Глисона = 7 или кли нической стадией T2b; к группе высокого риска были от несены пациенты с ПСА > 20 нг / мл, индексом Глисона > 7 или клинической стадией ≥ T2c. Для каждой такой груп пы характерна определенная тактика и методы лечения. Согласно практическим рекомендациям по диагности ке и лечению рака предстательной железы Ассоциации онкологов России (АОР) [4], для пациентов РПЖ группы умеренного риска прогрессирования заболевания и ожи даемой продолжительностью жизни более 10 лет обычно проводятся ДЛТ в сочетании с коротким курсом гормо нотерапии (4–6 мес.) или РПЭ с возможной лимфаденэк томией. Основные преимуще ства метода заключаются в малоинвазивности, удобстве проведения, возможности сохранения качества жизни, сравнимого с дооперационным уровнем, минимальные осложнения и сроки госпитализации
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