Link P, Freiha F S, Stamey T A
Division of Urology, Stanford University Medical Center, California.
J Urol. 1991 Mar;145(3):532-4. doi: 10.1016/s0022-5347(17)38388-x.
Adjuvant radiation therapy following radical prostatectomy for adenocarcinoma of the prostate was given to 25 patients. Of these patients 8 had microscopic lymph node metastasis, 8 had seminal vesicle invasion without positive lymph nodes, 6 had positive surgical margins and 3 had only capsule penetration. Their only evidence of residual disease was detectable serum prostate specific antigen (PSA) by the Yang assay. A total of 15 patients (60%) had a subsequent decrease in PSA to less than 0.3 ng./ml. and an additional 5 (20%) had a decrease in PSA by more than 50%. Currently 8 patients have no detectable PSA after a median followup of 18 months (17 to 38 months) since initiating radiation therapy. Only 1 of 12 patients with detectable PSA immediately after radical prostatectomy has had a durable response to adjuvant radiation therapy. In contrast 7 of 13 patients with a delayed increase in PSA had a durable response. The ability of adjuvant radiation therapy to eliminate serum PSA in patients with a delayed increase in PSA after radical prostatectomy is encouraging. However, longer followup, including the use of nonradiated control subjects, is needed to assess the ability of adjuvant radiation therapy to control local disease and prolong patient survival.
25例前列腺腺癌患者在根治性前列腺切除术后接受了辅助性放射治疗。这些患者中，8例有显微镜下淋巴结转移，8例有精囊侵犯但淋巴结无转移，6例手术切缘阳性，3例仅包膜穿透。他们残留疾病的唯一证据是通过杨式检测法可检测到血清前列腺特异性抗原（PSA）。共有15例患者（60%）随后PSA降至低于0.3 ng/ml，另有5例（20%）PSA下降超过50%。目前，自开始放射治疗以来，经过18个月（17至38个月）的中位随访，8例患者的PSA检测不到。根治性前列腺切除术后立即PSA可检测到的12例患者中，只有1例对辅助性放射治疗有持久反应。相比之下，13例PSA延迟升高的患者中有7例有持久反应。辅助性放射治疗能够消除根治性前列腺切除术后PSA延迟升高患者的血清PSA，这一点令人鼓舞。然而，需要更长时间的随访，包括使用未接受放射治疗的对照受试者，以评估辅助性放射治疗控制局部疾病和延长患者生存期的能力。
