Natürliche Wege eine vergrößerte Prostata verkleinern
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Naoya Murakami. Keiichi Nakagawa. Jun Itami. Patients and Methods: From April through Septemberpatients with nonmetastatic prostate cancer underwent TPI without external-beam irradiation.
Median patient age was 70 years with a median follow-up of Clinical, treatment, and dosimetric parameters evaluated included age, initial prostate-specific antigen, Gleason Score, neoadjuvant hormone Prostatavolumen Zahl, initial IPSS, post-TPI prostatic volume, number of implanted seeds, prostate V, Prostatavolumen Zahl, D90, urethral Dmax, and urethral D In order to further evaluate detailed urethral doses, the base and apical urethra were defined and the dosimetric parameters were calculated.
Multivariate analysis demonstrated a statistically significant correlation of post-TPI prostatic volume, number of implanted seeds, and the dosimetric parameters of the base urethra with IPSS increment. Conclusion: The base urethra appears Prostatavolumen Zahl be susceptible to Prostatavolumen Zahl and the increased dose to this region deteriorates IPSS.
It remains unclear whether the base urethral dose relates to the incidence of late urinary morbidities. Patienten und Methodik: Von April bis September erhielten Prostatavolumen Zahl mit nichtmetastasiertem Prostatakarzi- nom eine alleinige transperineale permanente interstitielle Brachytherapie mit I ohne vorherige perkutane Therapie.
Das mittlere Patientenalter betrug 70 Jahre, die mediane Beobachtungszeit lag bei 13,0 Monaten. Zur detaillierten Untersuchung der Urethrabelastung wurden basale und apikale Urethra definiert, für die ebenfalls DVH-Parameter berechnet wurden.
Unklar bleibt, ob die Dosis in der basalen Urethra im Zusammenhang mit dem Auftreten urethraler Spät- wirkungen steht. Prostatavolumen Zahl the clinical experiences ac- margin was added to reduce Prostatavolumen Zahl rectal dose. In the preplan- cumulated for decades, guidelines on standardized TPI for ning, I seeds were placed with the modified Prostatavolumen Zahl load- localized prostate cancer were established [9, 16] and favor- ing to deliver Gy to the PTV.
The TPI was performed un- able long-term results were achieved [5, 14, 15, 18]. However, introduction of the periph- planning with intraoperative modifications. In the present study, the detailed urethral lation Prostatavolumen Zahl bleeding within the gland immediately after the Prostatavolumen Zahl doses of TPI were investigated in relation to the acute incre- plantation [9, 13, 16].
Table 1. Patient characteristics. PSA: prostate-specific antigen. Patients and Methods Tabelle Prostatavolumen Zahl. PSA: prostataspezifisches Antigen.
Clinical characteristics of the pa- Age yearsmedian range About 3 weeks before the implant, Neoadjuvant hormone therapy 73 70 prostate volumetry by axial transrectal ultrasound TRUS; Follow-up monthsmedian range The Figure 1.
Definitions of base and apical urethras. Definitionen der basalen und apikalen Urethra. Error bars represent standard deviations. Abbildung 2. Die Ziffern in der unteren Reihe entspre- chen der auswertbaren Patientenzahl im jeweiligen Zeitintervall. Die Fehlerbalken zeigen Prostatavolumen Zahl Standardabweichungen. T2-weighted magnetic the Prostatavolumen Zahl urethra. CT and MR images were structureand D90 were calculated.
The urethral dose was calcu- ables and the increment of IPSS were analyzed Prostatavolumen Zahl univariate lated at the Prostatavolumen Zahl rim of the Foley catheter from Prostatavolumen Zahl bladder analysis. The continuous variables were dichotomized to give neck to the CT slice where the most caudally located seed can the lowest p-values Prostatavolumen Zahl the t-test, where the increment of IPSS be found. The variables with p-values day following TPI until subsidence of urinary symptoms.
Postimplant IPSS was evaluated in the 1st and 4th larger and smaller increments, while the clinical and treatment weeks after the implant, and then every 2—3 months.
Various patient, tumor, and treatment factors as well as the TPI dosimetric factors were analyzed to Prostatavolumen Zahl statistically Results significant relationships with the increment of IPSS.
The urethral In seeds implanted ranged from 40 to with a mean of Total activity of the implanted seeds ranged from Prostatavolumen Zahl CT. The base urethra is defined as the most The mean prostate volume proximal 2—3 mm long portion of the prostatic Prostatavolumen Zahl actu- evaluated in post-TPI MR images was Prostate V ally, contouring two slices of CT images neighboring the ranged from Treatment and dosimetric characteristics.
Results of the univariate analysis to demonstrate the influence Prostate Symptom Score; SD: standard deviation; TPI: transperineal of clinical and dosimetric variables upon the increment Prostatavolumen Zahl Internation- permanent interstitial implant. For metric parameters refer to the text. Tabelle 2. Therapeutische und dosimetrische Charakteristika. IPSS: Tabelle 3. PSA: prostataspezifisches finitionen der dosimetrischen Parameter finden sich im Text.
Genaue Definitionen der dosimetrischen Parameter finden sich im Text. The urethral Dmax was higher in the apical the present study, the prostatic volume and the number of im- urethra as compared to the base urethra. Kelly et al. Although it is rational to assume that ure- related with the postimplant prostatic volume, number of im- thral dose is related to the increment of IPSS, Prostatavolumen Zahl relationship planted seeds, and the dosimetric parameters of the base ure- between them remains quite controversial.
Our study revealed thra Table 4. A higher dose to the base urethra caused Prostatavolumen Zahl that the dosimetric parameters of the base urethra have a sta- more unfavorable acute IPSS increment. Simi- larly, Williams et al. As we experienced only one patient with acute urinary reten- They consider the Prostatavolumen Zahl of seeds above the prostatic base to tion after TPI during this time period, we confined our analy- reflect the dose to the bladder neck and trigone which may be sis to the increment of IPSS as an acute urinary morbidity.
Pinkawa et al. By contrast, Allen et al. Results of the multivariate analysis to demonstrate the in- 2. Strahlenther Onkol ;— MRI: magnetic resonance 3. Side effects of permanent I imaging; PSA: prostate-specific antigen.
For detailed definitions of the prostate seed implants in patients treated in Prostatavolumen Zahl. Radiother Oncol Prostatavolumen Zahl. Factors influencing risk of acute urinary Tabelle 4. Ergebnisse der multivariaten Analyse, die den Einfluss der retention after TRUS-guided permanent prostate seed implantation.
MRI: Magnetresonanz- 5. Genaue Definitionen cific antigen control of prostate cancer with I brachytherapy. Int J Ra- der dosimetrischen Parameter finden sich im Text. Guckenberger M, Flentje M. Intensity-modulated radiotherapy IMRT of localized prostate cancer. Variables p-value 7. Prediction of urinary symptoms after iodine prostate brachytherapy. Decline in urinary retention in- MRI volume ml 0.
Seed 0. The Prostatavolumen Zahl of isotope and pros- Base urethra Dmax Gy 0. Base urethra D50 Gy 0. Serial changes of international prostate symptom score following I prostate brachytherapy. Int J Clin Oncol ;—5. Health-related quality of life after permanent interstitial brachytherapy for prostate cancer. Strahlenther nificant relationships between various segmental urethral Onkol ;—5.
Changes of dose delivery distribution although they showed the maximal IPSS is related to the max- within the first month after permanent interstitial brachytherapy for pros- tate cancer. They segmented the prostatic J Urol ;—6. Modern prostate brachytherapy. Pros- tate specific antigen results in patients with up to 12 years of observed tivity of this tiny region or bladder neck to radiation.
Cancer Prostatavolumen Zahl In this retrospective analysis, the patients included had Radiother Oncol TPI in our department. Therefore, in some patients the opti- ;—