Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke St. E., H2L 4M1, Montréal, QC, Canada.
CRCHUM-Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Strahlenther Onkol. 2018 Jan;194(1):17-22. doi: 10.1007/s00066-017-1176-z. Epub 2017 Jul 10.
To investigate the impact of 5‑alpha-reductase inhibitor (5-ARI) use on radiotherapy outcomes for localized prostate cancer.
We included 203 patients on a 5-ARI from our institutional database comprising over 2500 patients who had been treated with either external beam radiotherapy (EBRT) or brachytherapy for localized prostate cancer. Patients received a 5-ARI for urinary symptoms or active surveillance. Cancer progressions at the time of definitive treatment were analyzed according to the following criteria: (a) progression of Gleason score or increase in cancer volume on biopsy, (b) first biopsy positive for cancer after being treated for urinary symptoms with a 5-ARI, and (c) prostate-specific antigen (PSA) progression with or without a previous cancer diagnosis. Biochemical failure (BF) was defined by the Phoenix definition. Log-rank test was used for survival analysis.
At a median follow-up of 38.2 months (standard deviation 22.2 months), 10 (4.9%) patients experienced BF. Concerning prostate cancer progression criteria, 52% of men demonstrated none, 37% showed only one criterion, and 11% showed two. Using univariate analysis, PSA progression (p = 0.004) and appearance of a positive biopsy (p < 0.001) were significant predictive factors for BF, while Gleason progression (p = 0.3) was not. In multivariate analysis adjusted for cancer aggressiveness, rising PSA (hazard ratio, HR, 5.7; 95% confidence interval, CI, 1.1-28.8; p = 0.04) and the number of cancer progression factors (HR 2.9, 95% CI 1.2-7.0, p = 0.02) remained adverse risk factors.
PSA progression experienced during 5‑ARI treatment before radiotherapy is predictive of worse biochemical outcome. Such details should be considered when counseling men prior to radiation therapy.
探讨 5α-还原酶抑制剂（5-ARI）对局限性前列腺癌放疗结局的影响。
我们纳入了来自机构数据库的 203 名接受 5-ARI 治疗的患者，该数据库包含了 2500 多名接受外照射放疗（EBRT）或近距离放疗治疗局限性前列腺癌的患者。患者因尿症状或主动监测而接受 5-ARI 治疗。根据以下标准分析明确治疗时癌症进展情况：（a）前列腺活检时 Gleason 评分进展或肿瘤体积增加，（b）接受 5-ARI 治疗尿症状后首次活检阳性，（c）前列腺特异性抗原（PSA）进展，无论是否有之前的癌症诊断。生化失败（BF）定义为 Phoenix 定义。对数秩检验用于生存分析。
中位随访 38.2 个月（标准差 22.2 个月）时，10 例（4.9%）患者发生 BF。就前列腺癌进展标准而言，52%的男性无任何表现，37%的男性只有一个标准，11%的男性有两个标准。单因素分析显示，PSA 进展（p=0.004）和活检阳性（p<0.001）是 BF 的显著预测因素，而 Gleason 进展（p=0.3）则不是。在多变量分析中，调整了癌症侵袭性，PSA 升高（危险比，HR，5.7；95%置信区间，CI，1.1-28.8；p=0.04）和癌症进展因素数量（HR 2.9，95%CI 1.2-7.0，p=0.02）仍然是不良风险因素。
放疗前 5-ARI 治疗期间发生的 PSA 进展可预测生化结局较差。在进行放射治疗前，应考虑这些细节来为男性提供咨询。
