Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2012 Nov;188(5):1761-6. doi: 10.1016/j.juro.2012.07.037. Epub 2012 Sep 19.
We evaluated the long-term outcome of patients with biochemical recurrence following radical prostatectomy with adjuvant radiation therapy and determined predictors of systemic progression in these men.
We identified 134 men with biochemical recurrence following radical prostatectomy plus adjuvant radiation therapy for pT(any)N0M0 disease. Median followup was 13.1 years. Survival after biochemical recurrence was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with systemic progression after biochemical recurrence.
Overall, 41 patients (31.5%) with biochemical recurrence experienced systemic progression and 57 (42.5%) died, including 19 (14.2%) of prostate cancer. Median systemic progression-free and cancer specific survival were not attained at 15 years of followup after biochemical recurrence. Median time from prostatectomy to recurrence was 3.3 years. Ten-year cancer specific survival was not significantly different for patients who experienced biochemical recurrence less and greater than 3.3 years after radical prostatectomy (83% and 83%, respectively, p = 0.39). Moreover, on multivariate analysis increased pathological Gleason score (HR 1.78, p = 0.02) and rapid prostate specific antigen doubling time (less than 6-month doubling time HR 11.39, p <0.0001) were significantly associated with the risk of systemic progression.
The natural history of biochemical recurrence after radical prostatectomy plus adjuvant radiation therapy is heterogeneous with only a minority of these men experiencing systemic progression and death from prostate cancer. The decision to begin additional therapies in such patients must balance the risk of disease progression, based on pathological Gleason score and postoperative prostate specific antigen doubling time, against the cost and morbidity of treatment.
我们评估了根治性前列腺切除术加辅助放疗后生化复发患者的长期结果，并确定了这些患者发生全身进展的预测因素。
我们确定了 134 例根治性前列腺切除术加辅助放疗后生化复发的 pT（任何）N0M0 疾病患者。中位随访时间为 13.1 年。使用 Kaplan-Meier 方法估计生化复发后的生存情况。使用 Cox 比例风险回归模型分析与生化复发后全身进展相关的临床病理变量。
共有 41 例（31.5%）生化复发患者发生全身进展，57 例（42.5%）死亡，包括 19 例（14.2%）死于前列腺癌。生化复发后 15 年随访时，无中位系统性无进展生存期和癌症特异性生存期。从前列腺切除术到复发的中位时间为 3.3 年。生化复发时间小于 3.3 年和大于 3.3 年的患者 10 年癌症特异性生存率无显著差异（分别为 83%和 83%，p = 0.39）。此外，多变量分析显示，病理 Gleason 评分增加（HR 1.78，p = 0.02）和 PSA 倍增时间较快（小于 6 个月倍增时间 HR 11.39，p <0.0001）与全身进展的风险显著相关。
根治性前列腺切除术加辅助放疗后生化复发的自然史是异质的，只有少数患者发生全身进展和死于前列腺癌。在这些患者中，是否开始额外的治疗必须根据病理 Gleason 评分和术后 PSA 倍增时间来平衡疾病进展的风险，同时考虑治疗的成本和发病率。
