Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.
Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1315-21. doi: 10.1016/j.ijrobp.2009.06.052. Epub 2010 Jan 13.
To evaluate retrospectively the biochemical outcomes of young men treated with low-dose-rate brachytherapy for prostate cancer.
From 1990 to 2005, 1,665 men with clinically localized prostate cancer were treated with low-dose-rate brachytherapy +/- hormone therapy (HT) +/- external beam radiotherapy and underwent > or = 2 years of follow-up. Patients were stratified on the basis of age: < or = 60 (n = 378) and >60 years (n = 1,287). Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/mL. Univariate and multivariate analyses were used to determine the association of variables with freedom from biochemical failure (FFbF).
Median follow-up was 68 months (range, 24-180) for men < or = 60 years and 66 months (range, 24-200) for men >60. For the entire group, the actuarial 5- and 8-year FFbF rates were 94% and 88%, respectively. Men < or = 60 demonstrated similar 5- and 8-year FFbF (95% and 92%) compared with men >60 (93% and 87%; p = 0.071). A larger percent of young patients presented with low-risk disease; lower clinical stage, Gleason score (GS), and pretreatment PSA values; were treated after 1997; did not receive any HT; and had a high biologic effective dose (BED) of radiation (all ps <0.001). On multivariate analysis, PSA (p = 0.001), GS (p = 0.005), and BED (p < 0.001) were significantly associated with FFbF, but age was not (p = 0.665).
Young men achieve excellent 5- and 8-year biochemical control rates that are comparable to those of older men after prostate brachytherapy. Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer.
回顾性评估低剂量率近距离放射治疗前列腺癌的年轻男性患者的生化结局。
从 1990 年至 2005 年，1665 例临床局限性前列腺癌患者接受低剂量率近距离放射治疗 +/-激素治疗（HT） +/-外部束放射治疗，并随访> = 2 年。患者按年龄分层：< = 60 岁（n = 378）和> 60 岁（n = 1287）。生化失败定义为前列腺特异性抗原（PSA）最低点加 2ng/ml。采用单因素和多因素分析确定变量与生化无失败（FFbF）的相关性。
中位随访时间为< = 60 岁的男性为 68 个月（范围为 24-180），> 60 岁的男性为 66 个月（范围为 24-200）。对于整个队列，5 年和 8 年的 FFbF 累积发生率分别为 94%和 88%。与> 60 岁的男性相比，< = 60 岁的男性具有相似的 5 年和 8 年 FFbF（95%和 92%）与 87%（p = 0.071）。年轻患者有更大比例的低危疾病；较低的临床分期、Gleason 评分（GS）和治疗前 PSA 值；在 1997 年后接受治疗；未接受任何 HT；且接受了较高的生物有效剂量（BED）的放射治疗（所有 ps <0.001）。多因素分析显示，PSA（p = 0.001）、GS（p = 0.005）和 BED（p < 0.001）与 FFbF 显著相关，但年龄无相关性（p = 0.665）。
年轻男性在接受前列腺近距离放射治疗后，5 年和 8 年的生化控制率优异，与老年男性相当。在考虑将近距离放射治疗作为临床局限性前列腺癌的主要治疗选择时，年轻年龄不应成为障碍。
