Meeks Joshua J, Kern Sean Q, Dalbagni Guido, Eastham James A, Sandhu Jaspreet S
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, and Urology Service, Department of Surgery, Tripler Army Medical Center (SQK), Honolulu, Hawaii.
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, and Urology Service, Department of Surgery, Tripler Army Medical Center (SQK), Honolulu, Hawaii.
J Urol. 2014 Jun;191(6):1760-3. doi: 10.1016/j.juro.2013.12.037. Epub 2013 Dec 25.
More than half of the men who receive treatment for prostate cancer elect radiotherapy. After radiotherapy recurrence is determined by an increase in prostate specific antigen and not usually by pathological confirmation. We describe the prevalence of persistent gradable prostate cancer in men treated with radiotherapy for prostate cancer at radical cystoprostatectomy for bladder cancer.
A total of 78 patients underwent radiotherapy (brachytherapy and/or external beam radiation) before the development of bladder cancer requiring radical cystectomy at our institution. All tissues were evaluated by a specialized genitourinary pathologist.
Median time from radiotherapy to radical cystoprostatectomy was 77 months. Gradable prostate cancer was identified in 45% of patients. Of the tumors 69% were Gleason score 7 or greater, 17% were pT3 or greater and 5% showed positive lymph nodes. Men treated more recently were less likely to have gradable prostate cancer, including 100% before 1980, 49% between 1980 and 2000 and 10% from 2000 to the present (p=0.002) as were those who received external beam radiation alone compared to brachytherapy and combined brachytherapy/external beam radiation (58% vs 27% and 14%, respectively, p=0.005).
After radiotherapy 45% of men had persistent prostate cancer (37% of men with no evidence of disease). A decreased prostate cancer rate was associated with later treatment year and combined brachytherapy/external beam radiation regimens. Similar to men treated with radical cystoprostatectomy for muscle invasive bladder cancer, meticulous attention should be paid during prostate removal in men treated with radiotherapy because many may have persistent prostate cancer. In addition, markers other than prostate specific antigen should be studied in men treated with radiotherapy to better identify those with biochemical recurrence.
接受前列腺癌治疗的男性中，超过一半选择放射治疗。放射治疗后，复发通过前列腺特异性抗原升高来判定，通常无需病理证实。我们描述了因膀胱癌接受根治性膀胱前列腺切除术的男性中，接受前列腺癌放射治疗后持续性可分级前列腺癌的患病率。
共有78例患者在我院因膀胱癌需要进行根治性膀胱切除术之前接受了放射治疗（近距离放射治疗和/或外照射）。所有组织均由专业的泌尿生殖病理学家进行评估。
从放射治疗到根治性膀胱前列腺切除术的中位时间为77个月。45%的患者发现有可分级前列腺癌。在这些肿瘤中，69%的Gleason评分为7分或更高，17%为pT3或更高，5%有阳性淋巴结。近期接受治疗的男性患可分级前列腺癌的可能性较小，包括1980年前为100%，1980年至2000年间为49%，2000年至今为10%（p = 0.002），与单独接受外照射的患者相比，接受近距离放射治疗以及近距离放射治疗与外照射联合治疗的患者也是如此（分别为58%、27%和14%，p = 0.005）。
放射治疗后，45%的男性患有持续性前列腺癌（37%的男性无疾病证据）。前列腺癌发病率的降低与较晚的治疗年份以及近距离放射治疗与外照射联合治疗方案有关。与因肌肉浸润性膀胱癌接受根治性膀胱前列腺切除术的男性相似，对接受放射治疗的男性进行前列腺切除时应格外小心，因为许多人可能患有持续性前列腺癌。此外，对于接受放射治疗的男性，应研究前列腺特异性抗原以外的标志物，以更好地识别那些生化复发的患者。
