Kaplan David J, Crispen Paul L, Greenberg Richard E, Chen David Y T, Viterbo Rosalia, Buyyounouski Mark K, Horwitz Eric M, Uzzo Robert G
Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Urology. 2008 Sep;72(3):654-8. doi: 10.1016/j.urology.2007.11.020. Epub 2008 Mar 4.
The incidence of histologic prostate cancer (CaP) after definitive radiation therapy (RT) for localized disease is rarely quantitated. We investigated the relationship between prostate-specific antigen (PSA) and histologically residual CaP after definitive RT in patients undergoing radical cystoprostatectomy (RCP) for unrelated indications.
We reviewed our prostate cancer database to identify patients undergoing RCP who previously received definitive RT for localized CaP. Pre-radiation variables examined include PSA, Gleason score, radiation modality, and dose. Post-radiation variables reviewed include PSA, time to RCP, the presence of histologically proven prostate cancer, and Gleason score.
We identified 21 patients who underwent RCP at a median of 60 months after RT for localized CaP. Pre-radiation Gleason scores were low (6 or less) to intermediate risk (3+4) in 82% (14 of 17), intermediate (4+3) to high (8 or greater) in 18% (3 of 17), and unavailable in 4 patients. Median pre-radiation PSA was 9 ng/mL. Median PSA before RCP in all patients was 0.8 ng/mL. A total of 52% (11 of 21) of patients demonstrated active CaP in the RCP specimen. Although 89% (16 of 18) of patients met the Phoenix definition of biochemical freedom from disease, 50% (8 of 16) of these patients had histologically residual CaP at the time of RCP. Median PSA was not significantly different between patients with and without active CaP.
Histologic evidence of CaP was noted in 50% of patients demonstrating biochemical freedom from disease at the time of RCP. Although the biological significance of active CaP in this select population is uncertain, our findings demonstrate the limitations of PSA in monitoring CaP disease activity after definitive RT.
对于局限性疾病进行根治性放疗（RT）后，组织学前列腺癌（CaP）的发生率鲜有定量研究。我们调查了因无关指征接受根治性膀胱前列腺切除术（RCP）的患者在根治性RT后前列腺特异性抗原（PSA）与组织学残留CaP之间的关系。
我们回顾了前列腺癌数据库，以确定之前因局限性CaP接受过根治性RT的RCP患者。放疗前检查的变量包括PSA、Gleason评分、放疗方式和剂量。回顾的放疗后变量包括PSA、至RCP的时间、组织学证实的前列腺癌的存在情况以及Gleason评分。
我们确定了21例患者，他们在因局限性CaP接受RT后的中位时间为60个月时接受了RCP。放疗前Gleason评分82%（17例中的14例）为低（6分或更低）至中度风险（3 + 4），18%（17例中的3例）为中度（4 + 3）至高（8分或更高），4例患者数据不可用。放疗前PSA中位数为9 ng/mL。所有患者RCP前PSA中位数为0.8 ng/mL。共有52%（21例中的11例）患者的RCP标本中显示有活动性CaP。尽管89%（18例中的16例）患者符合生化无病的Phoenix定义，但这些患者中有50%（16例中的8例）在RCP时存在组织学残留CaP。有和没有活动性CaP的患者之间PSA中位数无显著差异。
在RCP时显示生化无病的患者中，50%有CaP的组织学证据。尽管在这一特定人群中活动性CaP的生物学意义尚不确定，但我们的研究结果表明了PSA在监测根治性RT后CaP疾病活动方面的局限性。
