Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):529-33. doi: 10.1016/j.ijrobp.2013.02.004. Epub 2013 Mar 21.
To determine whether the response to neoadjuvant androgen deprivation therapy (ADT) defined by a decline in prostate-specific antigen (PSA) to nadir values is associated with improved survival outcomes after external beam radiation therapy (EBRT) for prostate cancer.
One thousand forty-five patients with localized prostate cancer were treated with definitive EBRT in conjunction with neoadjuvant and concurrent ADT. A 6-month course of ADT was used (3 months during the neoadjuvant phase and 2 to 3 months concurrently with EBRT). The median EBRT prescription dose was 81 Gy using a conformal-based technique. The median follow-up time was 8.5 years.
The 10-year PSA relapse-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 74.3%, compared with 57.7% for patients with higher PSA nadir values (P<.001). The 10-year distant metastases-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 86.1%, compared with 78.6% for patients with higher PSA nadir values (P=.004). In a competing-risk analysis, prostate cancer-related deaths were also significantly reduced among patients with pre-radiation therapy PSA nadirs of <0.3 ng/mL compared with higher values (7.8% compared with 13.7%; P=.009). Multivariable analysis demonstrated that the pre-EBRT PSA nadir value was a significant predictor of long-term biochemical tumor control, distant metastases-free survival, and cause-specific survival outcomes.
Pre-radiation therapy nadir PSA values of ≤0.3 ng/mL after neoadjuvant ADT were associated with improved long-term biochemical tumor control, reduction in distant metastases, and prostate cancer-related death. Patients with higher nadir values may require alternative adjuvant therapies to improve outcomes.
确定新辅助雄激素剥夺治疗（ADT）后前列腺特异性抗原（PSA）降至最低值的反应是否与前列腺癌接受外束放射治疗（EBRT）后的生存结果改善相关。
1045 例局限性前列腺癌患者接受根治性 EBRT 联合新辅助和同期 ADT 治疗。使用 6 个月疗程的 ADT（新辅助阶段 3 个月，与 EBRT 同时使用 2 至 3 个月）。EBRT 处方剂量的中位数为 81 Gy，采用基于适形的技术。中位随访时间为 8.5 年。
放射治疗前 PSA 最低值≤0.3ng/mL 的患者 10 年 PSA 无复发生存率为 74.3%，而 PSA 最低值较高的患者为 57.7%（P<.001）。放射治疗前 PSA 最低值≤0.3ng/mL 的患者 10 年远处转移无复发生存率为 86.1%，而 PSA 最低值较高的患者为 78.6%（P=.004）。在竞争风险分析中，与 PSA 最低值较高的患者相比，放射治疗前 PSA 最低值<0.3ng/mL 的患者前列腺癌相关死亡也显著减少（7.8%比 13.7%；P=.009）。多变量分析表明，EBRT 前 PSA 最低值是长期生化肿瘤控制、远处转移无复发生存和特定原因生存结果的显著预测因素。
新辅助 ADT 后 PSA 最低值≤0.3ng/mL 与长期生化肿瘤控制、远处转移减少和前列腺癌相关死亡的改善相关。PSA 最低值较高的患者可能需要替代辅助治疗以改善结局。
