目的 探讨125 I近距离治疗联合雄激素剥夺疗法治疗中‐高危局限性前列腺癌的长期疗效及安全性. 方法 回顾性分析125 I近距离治疗联合雄激素剥夺疗法治疗的36例局限性中‐高危前列腺癌患者的临床及随访资料.患者中位年龄65岁,均经前列腺穿刺活检病理证实为前列腺腺癌,GLeason评分7～8分.临床分期:T2a 期9例,T2b 期17例,T2c 期10例.血清PSA 5.8～26.2 ng／mL ,中位PSA 为12 .8 ng／mL .根据前列腺癌危险度分级,均为局限性前列腺癌,其中中危组20例、高危组16例.125 I放射性粒子处方剂量均为145 Gy .雄激素剥夺疗法采取LHRH药物去势联合比卡鲁胺抗雄治疗,中危组行辅助治疗6个月,高危组辅助治疗12个月.全部患者术后随访60～72个月,中位随访时间为60个月. 结果 患者治疗6个月后 PSA均降至0 .2 ng／mL以下, PSA最低值0 .003 ng／mL ,中位PSA 0 .01 ng／mL .中危组中出现生化复发2例,恢复内分泌治疗有效,未出现临床复发.高危组中出现前列腺局部复发1例,行挽救性前列腺癌根治术后 PSA降至0 .003 ng／mL ;出现生化复发1例,恢复内分泌治疗有效.随访过程中无患者死亡. 5年总生存率为100%;中危组的肿瘤无进展生存率为 90 .0%,高危组为 87 .5%,两者差异无统计学意义(P＝0 .816) .近距离治疗不良反应:尿路症状Ⅰ级22%(8／36) 、尿路症状Ⅱ级6%(2／36) 、直肠症状Ⅰ级8%(5／36) ,以上不良反应均于1年内消失.内分泌治疗不良反应:性欲减退100%(36／36) 、勃起功能障碍100%(36／36 ) 、潮热 50%(18／36 ) 、乏力 33%(12／36 ) 、乳房肿痛 25%(9／36 ) 、恶心14%(5／36) 、贫血5%(2／36) 、抑郁3%(1／36) ,停药后均消失. 结论 125 I近距离治疗联合雄激素剥夺疗法治疗中‐高危局限性前列腺癌是一种安全有效的治疗方法.中危组辅助内分泌治疗6个月与高危组辅助内分泌治疗12个月的肿瘤学预后相近.%Objective To expLore the Long‐term efficacy and safety of 125 I brachytherapy com‐bined with androgen deprivation therapy (ADT ) for the treatment of intermediate to high‐risk LocaL‐ized prostate cancer . Methods T hirty‐six cases of LocaLized prostate cancer treated with 125 I brachytherapy combined with ADT were retrospectiveLy anaLyzed .T he median age of the patients was 65 years .T he pathoLogicaL diagnosis of prostate biopsy was confirmed as adenocarcinoma ,and the GLeason score was 7‐8 .CLinicaL staging showed :9 cases in T2a ,17 cases in T2b ,and 10 cases in T2c stage.Serum PSA vaLue ranged from 5 .8 ng／mL to 26 .2 ng／mL with a median of 12 .8 ng／mL . According to the risk cLassification of prostate cancer ,20 cases were in the intermediat‐risk group and 16 cases in the high‐risk group .T he prescription dose of 125 I radioactive particLes was 145 Gy , and combined androgen bLockade using L HRH agonist and bicaLutamide were performed .T he inter‐mediate‐risk group received adjuvant therapy for 6 months and the high‐risk group for 12 months . ALL patients were foLLowed up for 60‐72 months ,with a median period of 60 months . ResuLts PSA vaLue of these patients decreased to beLow 0 .2 ng／mL ,and the Lowest vaLue was 0 .003 ng／mL with the median of 0 .01 ng／mL in 6 months .Two cases of biochemicaL recurrence occurred in the intermediate‐risk group and 1 case in the high‐risk group ,and effective endocrine therapy was administered again .LocaL recurrence occurred in 1 case in the high‐risk group ,and the PSA decreased to 0 .003 ng／mL after saLvage radicaL prostatectomy being performed .No patient died during foLLow‐up.T he 5‐year overaLL survivaL rate is 100%,and the 5‐year tumor progression‐free survivaL rate was 90 .0% in the intermediate‐risk group and 87 .5% in the high‐risk group .T here was no significant difference between the two groups (P＝0 .816).Adjacent treatment adverse reactions :u‐rinary tract symptoms :grade Ⅰ 22%(8／36) ,grade Ⅱ 6%(2／36) ;rectaL symptoms :grade Ⅰ 8%(5／36 ).ALL the above adverse reactions disappeared within one year .Endocrine therapy adverse reactions :Loss of Libido 100%(36／36) ,erectiLe dys‐function 100%(36／36) ,hot fLash 50%(18／36) ,fatigue 33%(12／36) ,breast sweLLing 25%(9／36) ,nausea 14%(5／36) ,a‐nemia 5%(2／36) ,depression 3%(1／36).The symptoms aLL disappeared after stopping the drug . ConcLusions 125 I brachy‐therapy combined with ADT for the treatment of intermediate to high‐risk LocaLized prostate cancer is effective and safety .T he 6‐month adjuvant ADT in the moderate‐risk group and the 12‐month adjuvant ADT in the high‐risk group showed a simiLar tumor prognosis .
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