摘要：研究者现在认为，一般用于年老病患的前列腺近接治疗也可以用于年轻男性。研究者于美国治疗放射暨肿瘤学会(ASTRO)第49届年会中发表指出，年轻人接受放射株植入疗法（radiation seed implant therapy）有极佳的 5年生化控制。ASTRO教育谘询主席、哈佛医学院的Anthony Zietman医师在出席记者会时表示，更侵犯式的方式是手术......
研究者现在认为，一般用于年老病患的前列腺近接治疗也可以用于年轻男性；研究者于美国治疗放射暨肿瘤学会(ASTRO)第49届年会中发表指出，年轻人接受放射株植入疗法（radiation seed implant therapy）有极佳的 5年生化控制。
ASTRO教育谘询主席、哈佛医学院的Anthony Zietman医师在出席记者会时表示，
侵犯式的方式是手术，但是病患可以有所选择，只不过因为植入株治疗不一定会提供给年轻病患而选择较少；女性在乳癌治疗上有更多选择，男性在
方面落后女性30年。
ASTRO新闻的编辑、布莱根妇女医院的Phillip Devlin医师在访谈中表示，这是一篇来自Mount Sinai医学中心的杰出研究，负责该研究的是Richard Stock医师和Nelson Stone医师，Devlin医师称他们为"精力旺盛的先驱知识份子"。
有关前列腺切除和近接治疗的争论，长久以来被热烈讨论着， 医师一般因为专业和有时带点偏见而各执己见。
就在上
月，日内瓦癌症注册中心的瑞士研究者在内科医学档案期刊发表一篇研究，提倡手术的好处 (Merglen A 等人，Arch Intern Med. 2007;167:1944-1950)；研究团队批评该领域缺乏决定性的证据 ，结论认为，手术提供前列腺癌治疗的最佳长期好处–特别是存活率，尤其是年轻病患和肿瘤分化不佳的病患。
【避免手术的好处与风险】
Devlin医师同意此一领域缺乏资料，但是，尽管缺乏证据，他在20年前首次提供病患（包括年轻病患在内）放射株植入疗法；Devlin医师表示，我们有许多人从事这种疗法，我们往往被认为是不顾后果的，但是前列腺初除术病患的术后恢复时间需要数周，可能会导致一些负面影响。
Devlin医师表示，直言不讳的，我希望病患在治疗后可以打高尔夫，也可以有性生活；这些在手术后都无法达成；Devlin医师表示，他在这次发表的最新研究中再度确认，显示我们这样做是可以的。
然而，有关次级癌症潜在增加的风险呢？在研究发表后的问答时间中，布莱根妇女医院的Anthony D'Amico医师表示，泌尿科医师倾向手术的原因之一就是担心这个风险。
他引述会议中一篇有关单纯放射线治疗和近接治疗(无手术)后的次级癌症风险的海报， 这些病患的次级癌症风险只有300分之1，他请研究发表人，Mount Sinai医学中心的Alice Ho医师对此风险提出看法。
Ho医师回应表示，努力追踪这些病患是关键所在，当医师评估风险时，必须将其是否仔细观察病患纳入考量。
研究者研究了超过1,700位前列腺近接治疗和荷尔蒙治疗的病患，病患的临床前列腺分期为T1 或者T2，试验终点是生化成功预测性，追踪期为 2到16年(平均 5年)。
研究者发现年轻病患在放射株植入疗法之后的生化结果和年长病患相当。
以年龄分组的5年生化成功分析
|
年纪(岁)
|
5 年生化成功预测性 ( %)
|
平均追踪期(月)
|
P
|
|
< 60
|
96
|
59
|
.001
|
|
61–75
|
92
|
62
|
.001
|
|
> 76
|
88
|
54
|
.001
|
单一变项分析中，研究者发现年轻病患比年长病患有较佳的5年生化成功预测性，但他们认为这是因为低风险疾病的年轻人比率较高，这些人被以较高的放射线剂量治疗。
尽管有这些潜在限制，Ho 医师指出，该研究对传统认为的年纪是前列腺癌一个负面预后因子的看法提出质疑，她在记者会中表示，我们的研究中有更高百分比的年轻病患是低风险级病，我们在接受放射株植入疗法的年轻病患和年长病患之间的前列腺特定抗原控制并无差异。
研究者结论表示，必须对诊断为局部前列腺癌的年轻病患提供所有的治疗选择，包括近接治疗。
研究者宣称无相关财经关系。
美国治疗放射暨肿瘤学会第49届年会：摘要160。于2007年10月31日发表。
Young Age Not a Deterrent for Prostate Brachytherapy, Study Shows
By Allison Gandey
Medscape Medical News
Researchers are now suggesting that prostate brachytherapy, generally reserved for older patients, can be a valuable alternative to surgery for younger men as well. Presenting here at the American Society for Therapeutic Radiology and Oncology (ASTRO) 49th Annual Meeting, investigators showed excellent 5-year biochemical control in young men who had radiation seed implants.
"The more aggressive approach is surgery," Anthony Zietman, MD, from Harvard Medical School, in Boston, Massachusetts, and the education council chair for ASTRO, told reporters attending a news conference. "But patients like to have a choice, and their options have often been artificially narrowed because seed implants have not always been offered to younger patients. Men are about 30 years behind women, who have been offered more options when it comes to breast cancer therapy," he said.
"This is a very good study coming out of the Mount Sinai Medical Center," Phillip Devlin, MD, from Brigham and Women's Hospital, in Boston, and the editor of ASTRO News, said during an interview. On board for the study are Drs. Richard Stock and Nelson Stone, whom Dr. Devlin called "pioneers and intellectual powerhouses."
The debate over prostatectomy vs brachytherapy has been a long and often passionate deliberation, with clinicians generally divided by specialty and sometimes professional bias.
Just last month, Swiss researchers from the Geneva Cancer Registry published a study in the Archives of Internal Medicine promoting the benefits of surgery (Merglen A et al. Arch Intern Med. 2007;167:1944-1950). The group criticized the lack of conclusive evidence in the field and concluded that "surgery offers the best chance of long-term prostate cancer–specific survival, in particular for younger patients and patients with poorly differentiated tumors."
Avoiding Surgery Affords Benefits and Risks
Dr. Devlin agreed there has been a lack of data in this area. But despite the absence of evidence, he was among the first, 20 years ago, to offer patients — including younger men — the option of radiation seed implants. "There were a number of us pursuing this, and we were widely seen as reckless," Dr. Devlin said. But the surgical recovery time for patients undergoing prostatectomy is weeks and can result in a number of negative effects.
"To be blunt," Dr. Devlin said, "I had patients who wanted to be able to play golf after treatment and they wanted to be able to have sex after that. It wasn't going to happen with surgery."
Dr. Devlin says he is reassured by this latest study presented at the meeting. "This shows it was okay for us to have done what we did."
But what about the potential increased risk for secondary cancers? During the question period after the presentation of the study, Anthony D'Amico, MD, PhD, from Brigham and Women's Hospital, said that 1 of the reasons urologists in particular tend to err on the side of surgery is because many are concerned about this risk.
He cited a poster from the meeting that looked at the risk for secondary cancers after radiation alone and after brachytherapy (with no surgery). He said the risk for secondary cancers in these patients was just 1 in 300. He asked lead author and presenter Alice Ho, MD, from Mount Sinai in New York, to comment on this risk.
Dr. Ho responded that diligent follow-up of these patients is key and that, when a physician is assessing risk, determining whether it will be possible to closely observe a patient should be taken into account.
The investigators looked at more than 1700 patients treated with prostate brachytherapy and hormone therapy. Patients had clinically localized prostate cancer T1 or T2. The end point for the trial was biochemical freedom from failure, and follow-up ranged from 2 to 16 years (median, 5 years).
The researchers found that young men had biochemical outcomes equivalent to older men after radiation seed implants.
Results of 5-Year Biochemical Freedom From Failure by Age Group
| Age, y |
5-Year Biochemical Freedom From Failure, % |
Median Follow-Up, mo |
P |
| < 60 |
96 |
59 |
.001 |
| 61–75 |
92 |
62 |
.001 |
| > 76 |
88 |
54 |
.001 |
On univariate analysis, the researchers found that the young men had better 5-year biochemical freedom from failure than older men, but they caution that this might be due to the greater percentage of young men who presented with low-risk disease and who were treated more recently with higher doses of radiation.
Despite these potential limitations, Dr. Ho pointed out that this study questions the traditional view that age is a negative prognostic factor in prostate cancer. "A greater percentage of younger men in our study presented with low-risk disease," she told reporters attending a news conference. "And we saw no difference in prostate-specific–antigen control rates younger men older men treated with seed implant."
The investigators concluded that younger men diagnosed with localized prostate cancer should be presented with all treatment options, including brachytherapy.
The researchers have disclosed no relevant financial relationships.
American Society for Therapeutic Radiology and Oncology 49th Annual Meeting: Abstract 160. Presented October 31, 2007.
发布日期：2008-3-26
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