Catton Charles, Milosevic Michael
Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, 610 University Avenue, M5G 2M9, Toronto, Canada.
World J Urol. 2003 Sep;21(4):243-52. doi: 10.1007/s00345-003-0360-1. Epub 2003 Aug 16.
Biochemical relapse will occur in 17-64% of men who undergo radical prostatectomy, and up to a third of men with biochemical relapse will progress to develop metastatic disease and ultimately die of prostate cancer. Postoperative salvage radiotherapy (RT) to the prostatic fossa is well-tolerated and potentially curative treatment and should be considered for all men who have biochemical relapse following prostatectomy. Gleason score <8, prostate-specific antigen (PSA) doubling time >10 months and PSA re-emergence >2 years following surgery predict for a low risk of early metastatic failure, but even men with no favourable prognostic factors may have a long-term durable response to RT and should not be excluded from consideration of treatment on the basis of these factors alone. Positive surgical margin status and a positive anastomotic biopsy do not predict response to RT, and routine biopsy is not recommended. PSA level at time of RT is a strong indicator of durable response to RT. No one PSA cutpoint level appears to be more significant, and early RT is likely more effective than late. Contemporary PSA assays can detect biochemical relapse in the 0.01-0.2 range, and this may provide additional therapeutic advantage if treatment can be given when tumour burden is smallest. There is an urgent need for prospective data from randomised trials to optimally select patients for salvage RT, to determine the optimal time to initiate treatment and to determine the role of adjuvant hormone therapy, and all patients should be considered for entry into ongoing and future clinical trials.
接受根治性前列腺切除术的男性中，17%至64%会出现生化复发，且高达三分之一生化复发的男性会进展为转移性疾病并最终死于前列腺癌。对前列腺窝进行术后挽救性放疗（RT）耐受性良好且可能治愈，对于所有前列腺切除术后出现生化复发的男性都应考虑采用。 Gleason评分<8、前列腺特异性抗原（PSA）倍增时间>10个月以及术后PSA再次出现>2年预示早期转移失败风险低，但即使没有有利预后因素的男性对RT也可能有长期持久反应，不应仅基于这些因素就排除其接受治疗的考虑。手术切缘阳性状态和吻合口活检阳性不能预测对RT的反应，不建议进行常规活检。RT时的PSA水平是对RT持久反应的有力指标。没有一个PSA切点水平显得更具意义，早期RT可能比晚期更有效。当代PSA检测可在0.01 - 0.2范围内检测出生化复发，如果能在肿瘤负荷最小时给予治疗，这可能会带来额外的治疗优势。迫切需要来自随机试验的前瞻性数据，以优化选择接受挽救性RT的患者，确定开始治疗的最佳时间，并确定辅助激素治疗的作用，所有患者都应考虑纳入正在进行和未来的临床试验。
