British Columbia Cancer Agency, Vancouver Island Centre, Radiation Therapy Program, Victoria, British Columbia, Canada.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e713-9. doi: 10.1016/j.ijrobp.2010.11.068. Epub 2011 Jan 27.
To examine the impact of patient, disease, and treatment characteristics on survival outcomes in patients treated with neoadjuvant androgen deprivation therapy (ADT) and radical external-beam radiotherapy (RT) for clinically localized, extreme-risk prostate adenocarcinoma with a presenting prostate-specific antigen (PSA) concentration of >40 ng/ml.
A retrospective chart review was conducted of 64 patients treated at a single institution between 1991 and 2000 with ADT and RT for prostate cancer with a presenting PSA level of >40 ng/ml. The effects of patient age, tumor (presenting PSA level, Gleason score, and T stage), and treatment (total ADT duration and pre-RT PSA level) characteristics on rates of biochemical disease-free survival (bDFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were examined.
Median follow-up time was 6.45 years (range, 0.09-15.19 years). Actuarial bDFS, PCSS, and OS rates at 5 years were 39%, 87%, and 78%, respectively, and 17%, 64%, and 45%, respectively, at 10 years. On multivariate analysis, the pre-RT PSA level (≤0.1 versus >0.1 ng/ml) was the single most significant prognostic factor for bDFS (p=0.033) and OS (p=0.018) rates, whereas age, T stage, Gleason score, and ADT duration (≤6 versus >6 months) were not predictive of outcomes.
In prostate cancer patients with high presenting PSA levels, >40 ng/ml, treated with combined modality, neoadjuvant ADT, and RT, the pre-RT PSA nadir, rather than ADT duration, was significantly associated with improved survival. This observation supports the use of neoadjuvant ADT to drive PSA levels to below 0.1 ng/ml before initiation of RT, to optimize outcomes for patients with extreme-risk disease.
探讨新辅助雄激素剥夺治疗（ADT）联合根治性外照射放疗（RT）治疗初诊 PSA ＞40ng/ml 的局部晚期高危前列腺腺癌患者的生存结果，分析患者、疾病和治疗特征的影响。
对 1991 年至 2000 年在单一机构接受 ADT 联合 RT 治疗的 64 例初诊 PSA ＞40ng/ml 的前列腺癌患者进行回顾性图表分析。研究了患者年龄、肿瘤（初诊 PSA 水平、Gleason 评分和 T 分期）和治疗（ADT 总持续时间和 RT 前 PSA 水平）特征对生化无病生存率（bDFS）、前列腺癌特异性生存率（PCSS）和总生存率（OS）的影响。
中位随访时间为 6.45 年（范围：0.09-15.19 年）。5 年时的累积 bDFS、PCSS 和 OS 率分别为 39%、87%和 78%，10 年时分别为 17%、64%和 45%。多因素分析显示，RT 前 PSA 水平（≤0.1 与＞0.1ng/ml）是 bDFS（p=0.033）和 OS（p=0.018）的唯一显著预后因素，而年龄、T 分期、Gleason 评分和 ADT 持续时间（≤6 与＞6 个月）与结局无关。
对于初诊 PSA ＞40ng/ml、接受新辅助 ADT 联合 RT 综合治疗的前列腺癌患者，RT 前 PSA 最低点而非 ADT 持续时间与生存改善显著相关。这一观察结果支持在开始 RT 前使用新辅助 ADT 将 PSA 水平降至＜0.1ng/ml，以优化高危疾病患者的结局。
