Matsumoto Kazuhiro, Mizuno Ryuichi, Tanaka Nobuyuki, Ide Hiroki, Hasegawa Masanori, Ishida Masaru, Hayakawa Nozomi, Yasumizu Yota, Hagiwara Masayuki, Hara Satoshi, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Nakajima Yosuke, Nakamura So, Nakashima Jun, Oya Mototsugu
Department of Urology, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
Med Oncol. 2014 Jul;31(7):45. doi: 10.1007/s12032-014-0045-1. Epub 2014 Jun 10.
The present study was undertaken to examine biochemical progression in patients who received salvage hormonal therapy (HT) for biochemical disease recurrence (BCR) after radical prostatectomy (RP), and to determine the optimal timing for the administration of HT. The study population consisted of 156 patients who underwent RP and received salvage HT for BCR. The starting point of this study was the timing of RP, and the endpoint was biochemical prostate-specific antigen (PSA) progression (castration-resistance) after HT. The mean follow-up period after surgery was 8.1 years. First, we excluded 18 patients with persistent PSA (≥ 0.2 ng/mL) after RP from an analysis below because their prognoses were significantly poorer compared with 138 patients whose PSA nadirs had reached <0.2 ng/mL. Multivariate analysis demonstrated that Gleason score ≥ 8 (p = 0.010, hazard ratio (HR) 3.02), and PSA doubling time (PSA-DT) <6 months (p = 0.001, HR 7.39) was independently associated with subsequent biochemical progression after HT. Using these two variables (Gleason score and PSA-DT), we could stratify patients into three risk groups for BCR after salvage HT. Regarding the optimal timing for HT administration for these high-risk patients with both risk factors (relative risk = 22.3), the PSA cutpoint of 1.0 ng/mL at the initiation of HT showed a significant difference in progression-free survival rates (p = 0.023). The findings indicated that for high-risk patients, salvage HT for BCR after PSA nadir (<0.2 ng/mL) should be started before the PSA level exceeds 1.0 ng/mL; otherwise, there is a significant risk of subsequent biochemical progression after HT.
本研究旨在探讨接受挽救性激素治疗（HT）以应对根治性前列腺切除术（RP）后生化复发（BCR）的患者的生化进展情况，并确定HT给药的最佳时机。研究人群包括156例行RP并接受挽救性HT治疗BCR的患者。本研究的起点为RP时间，终点为HT后生化前列腺特异性抗原（PSA）进展（去势抵抗）。术后平均随访期为8.1年。首先，我们将18例RP后PSA持续升高（≥0.2 ng/mL）的患者排除在以下分析之外，因为与138例PSA最低点达到<0.2 ng/mL的患者相比，他们的预后明显较差。多变量分析表明，Gleason评分≥8（p = 0.010，风险比（HR）3.02）以及PSA倍增时间（PSA-DT）<6个月（p = 0.001，HR 7.39）与HT后随后的生化进展独立相关。使用这两个变量（Gleason评分和PSA-DT），我们可以将患者分为挽救性HT后BCR的三个风险组。对于这两个风险因素均存在的高危患者（相对风险 = 22.3），HT开始时PSA切点为1.0 ng/mL在无进展生存率方面显示出显著差异（p = 0.023）。研究结果表明，对于高危患者，在PSA最低点（<0.2 ng/mL）后针对BCR的挽救性HT应在PSA水平超过1.0 ng/mL之前开始；否则，HT后随后发生生化进展的风险显著。
