Morris Lucinda May, Izard Michael Anthony, Wan Wai-Yin
Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia.
Department of Radiotherapy, Mater Hospital, North Sydney, New South Wales, Australia.
Brachytherapy. 2015 May-Jun;14(3):322-8. doi: 10.1016/j.brachy.2014.11.002. Epub 2014 Dec 5.
To evaluate whether nadir prostate-specific antigen (nPSA), time to nPSA (TnPSA), and nPSA 3-years post-treatment are prognostic for prostate cancer (PC) in patients treated with temporary brachytherapy plus external beam radiation therapy (EBRT) and hormonal manipulation.
We retrospectively analyzed our database of 253 patients with Stage T1-T3 N0M0 PC who underwent brachytherapy with temporary brachytherapy plus EBRT. All patients received neoadjuvant androgen deprivation for a median of 6 months. Treatment consisted of three pulses of pseudo pulsed-dose-rate brachytherapy to a median dose of 18Gy with 50.4Gy in 28 fractions of EBRT. Treatment took place between December 1999 and March 2006.
At a median of 6-years followup, nPSA value was a predictor of biochemical control. Rising nPSA categories of <0.01, 0.01-<0.05, 0.05-≤0.1, 0.1-≤ 1.0, or >1.0 ng/mL correlated with a deteriorating 5-year biochemical control (nBED) by the Phoenix definition of 100%, 90.0%, 82.5%, 64.3%, and 10%, respectively. A highly statistically significant relationship between nPSA value and subsequent clinical failure is also demonstrated. The relationship between TnPSA and nBED was strongly significant (p<0.0001), with a significantly longer nPSA for patients who had Phoenix nBED. A PSA of <1.5 ng/mL achieved 3-year post radiation therapy was prognostic for biochemical and clinical disease control (p<0.0001).
The nPSA, TnPSA, and reaching a PSA cutoff level of <1.5 ng/mL at 3 years post-treatment can provide useful prognostic information on long-term biochemical and clinical control of PC in patients treated with pseudo PDR, EBRT, and hormone manipulation.
评估最低点前列腺特异性抗原（nPSA）、达到nPSA的时间（TnPSA）以及治疗后3年的nPSA对接受临时近距离放射治疗加外照射放疗（EBRT）及激素治疗的前列腺癌（PC）患者是否具有预后价值。
我们回顾性分析了253例T1 - T3 N0M0期PC患者的数据库，这些患者接受了临时近距离放射治疗加EBRT。所有患者接受了中位时间为6个月的新辅助雄激素剥夺治疗。治疗包括三个脉冲的伪脉冲剂量率近距离放射治疗，中位剂量为18Gy，同时进行50.4Gy分28次的EBRT。治疗于1999年12月至2006年3月期间进行。
在中位6年的随访中，nPSA值是生化控制的一个预测指标。nPSA类别升高至<0.01、0.01 - <0.05、0.05 - ≤0.1、0.1 - ≤1.0或>1.0 ng/mL分别与根据Phoenix定义的5年生化控制（nBED）恶化相关，分别为100%、90.0%、82.5%、64.3%和10%。还证实了nPSA值与随后临床失败之间具有高度统计学意义的关系。TnPSA与nBED之间的关系非常显著（p<0.0001），对于具有Phoenix nBED的患者，nPSA显著更长。放疗后3年PSA<1.5 ng/mL对生化和临床疾病控制具有预后价值（p<0.0001）。
nPSA、TnPSA以及治疗后3年达到<1.5 ng/mL的PSA临界值可为接受伪PDR、EBRT和激素治疗的PC患者的PC长期生化和临床控制提供有用的预后信息。
