Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):883-8. doi: 10.1016/j.ijrobp.2010.11.049. Epub 2011 Feb 6.
To investigate the association between prostate specific antigen (PSA) bounce and disease outcome after prostate brachytherapy.
We analyzed 975 patients treated with (125)I implantation monotherapy between 1992 and 2006. All patients had tumor Stage ≤ 2c, Gleason score ≤ 7 prostate cancer, a minimum follow-up of 2 years with at least four PSA measurements, and no biochemical failure in the first 2 years. Median follow-up was 6 years. Bounce was defined as a PSA elevation of +0.2 ng/mL with subsequent decrease to previous nadir. We used the Phoenix +2 ng/mL definition for biochemical failure. Additional endpoints were disease-specific and overall survival. Multivariate Cox regression analysis was performed to adjust for potential confounding factors.
Bounce occurred in 32% of patients, with a median time to bounce of 1.6 years. More than 90% of bounces took place in the first 3 years after treatment and had disappeared within 2 years of onset. Ten-year freedom from biochemical failure, disease-specific survival, and overall survival rates were, respectively, 90%, 99%, and 88% for the bounce group and 70%, 93%, and 82% for the no-bounce group. Only 1 patient (0.3%) died of prostate cancer in the bounce group, compared with 40 patients (6.1%) in the no-bounce group. Adjusted for confounding, a 70% biochemical failure risk reduction was observed for patients experiencing a bounce (hazard ratio 0.31; 95% confidence interval 0.20-0.48).
A PSA bounce after prostate brachytherapy is strongly related to better outcome in terms of biochemical failure, disease-specific survival, and overall survival.
探讨前列腺特异性抗原（PSA）反弹与前列腺近距离放射治疗后疾病转归的关系。
我们分析了 1992 年至 2006 年间接受（125）I 植入单药治疗的 975 例患者。所有患者均患有肿瘤分期≤2c、Gleason 评分≤7 的前列腺癌，随访时间至少 2 年，至少有 4 次 PSA 检测，前 2 年内无生化失败。中位随访时间为 6 年。PSA 反弹定义为 PSA 升高+0.2ng/ml，随后降至先前的最低点。我们使用 Phoenix+2ng/ml 定义来判断生化失败。其他终点是疾病特异性和总体生存。采用多变量 Cox 回归分析来调整潜在的混杂因素。
32%的患者出现 PSA 反弹，反弹的中位时间为 1.6 年。超过 90%的反弹发生在治疗后 3 年内，且在发病后 2 年内消失。在 PSA 反弹组中，10 年无生化失败、疾病特异性生存和总体生存率分别为 90%、99%和 88%，而在无 PSA 反弹组中，分别为 70%、93%和 82%。在 PSA 反弹组中仅有 1 例（0.3%）患者死于前列腺癌，而在无 PSA 反弹组中，有 40 例（6.1%）患者死于前列腺癌。经混杂因素调整后，PSA 反弹患者的生化失败风险降低了 70%（风险比 0.31；95%置信区间 0.20-0.48）。
前列腺近距离放射治疗后 PSA 反弹与生化失败、疾病特异性生存和总体生存的改善密切相关。
