Coblentz T R, Bissonette E A, Williams K R, Theodorescu D
Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
Prostate Cancer Prostatic Dis. 2002;5(3):219-25. doi: 10.1038/sj.pcan.4500585.
In patients presenting with clinically localized prostate cancer, the risk of biochemical failure increases significantly with higher Gleason scores, prostate specific antigen (PSA) levels, and clinical stages. Current surgical and radiotherapeutic approaches appear to offer limited success in patients with highly adverse prognostic factors. In an attempt to improve on these outcomes, we have combined external beam radiotherapy (EBRT) with a brachytherapy (BT) boost and neo adjuvant and adjuvant androgen ablation in a population at significant risk of biochemical failure. Here we present early biochemical progression data for this approach. From October 1997 to July 1999, 72 men with a serum PSA >or=10 ng/ml or Gleason score >or=7 or clinical stage >or=T2c (AJC/UICC 1992) underwent EBRT followed by palladium-103 BT. All patients underwent 8 months of combined androgen ablation with leuprolide and an oral antiandrogen beginning 3 months prior to initiation of EBRT. Patients were followed by PSA and digital rectal examination (DRE) at 3-month intervals and a chart review on all patients was carried out during July 2001. To allow comparisons to contemporary literature, Kaplan-Meier survival curves were generated utilizing three alternate definitions of biochemical recurrence: PSA >0.2 ng/ml, PSA >1.0 ng/ml, and the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definition of three consecutive rising PSAs. Our results indicate that when PSA >0.2 ng/ml was used to define biochemical progression, 88% (95% CI 80-97) of patients remained free of disease at 24 months. When PSA >1.0 ng/ml was used, 97% (CI 92-100) of patients remained disease free at 24 months. ASTRO criteria yielded 90% (CI 82-98) recurrence-free survival at 24 months. In conclusion, this very early report indicates that in patients who are at increased risk of biochemical failure, EBRT with a BT boost in conjunction with short-term androgen ablation offers potentially superior biochemical disease-free survival to contemporary alternative approaches in the literature. Clearly, longer follow-up is required to confirm the durability of this approach.
对于临床局限性前列腺癌患者，随着Gleason评分、前列腺特异性抗原（PSA）水平升高以及临床分期增加，生化复发风险显著上升。对于具有高度不良预后因素的患者，目前的手术和放射治疗方法似乎效果有限。为了改善这些结果，我们将外照射放疗（EBRT）与近距离放疗（BT）增敏以及新辅助和辅助雄激素剥夺相结合，用于具有显著生化复发风险的人群。在此，我们展示这种方法的早期生化进展数据。从1997年10月至1999年7月，72名血清PSA≥10 ng/ml或Gleason评分≥7或临床分期≥T2c（AJC/UICC 1992）的男性接受了EBRT，随后进行钯-103 BT。所有患者在开始EBRT前3个月开始接受8个月的亮丙瑞林和口服抗雄激素联合雄激素剥夺治疗。每3个月对患者进行PSA和直肠指检（DRE）随访，并在2001年7月对所有患者进行病历审查。为了与当代文献进行比较，利用生化复发的三种不同定义生成了Kaplan-Meier生存曲线：PSA>0.2 ng/ml、PSA>1.0 ng/ml以及美国放射肿瘤学会（ASTRO）关于连续三次PSA升高的共识定义。我们的结果表明，当使用PSA>0.2 ng/ml来定义生化进展时，88%（95%CI 80-97）的患者在24个月时无疾病复发。当使用PSA>1.0 ng/ml时，97%（CI 92-100）的患者在24个月时无疾病复发。根据ASTRO标准，24个月时无复发生存率为90%（CI 82-98）。总之，这份非常早期的报告表明，对于生化复发风险增加的患者，EBRT联合BT增敏以及短期雄激素剥夺与文献中当代的替代方法相比，可能提供更优的无生化疾病生存期。显然，需要更长时间的随访来证实这种方法的持久性。
