Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Anzhenli Street, Chaoyang District, Beijing, 100029, People's Republic of China.
World J Surg Oncol. 2018 Jun 11;16(1):107. doi: 10.1186/s12957-018-1395-5.
To assess the oncologic outcomes of radiation therapy (RT) combined with maximal androgen blockade (MAB) and prostate-specific antigen (PSA) kinetics in patients with localized, high-risk prostate carcinoma (PCa).
Three-hundred twenty individuals with localized PCa who underwent RT + MAB in 2001-2015 were evaluated retrospectively. All patients had received 36 months of MAB therapy and 45 Gy of pelvic irradiation, plus a dose-escalated external beam radiation therapy (DE-EBRT) boost to 76~81 Gy (MAB + EBRT group), or a low-dose-rate prostate permanent brachytherapy (LDR-PPB) boost to 110 Gy with I-125 (MAB + EBRT + PPB group).
Follow-up median is 90 months, ranging from 12 to 186 months; 117 (36.6%) and 203 (63.4%) cases underwent MAB + EBRT and MAB + EBRT + PPB, respectively. Multivariate Cox regression showed that the PPB regimen and PSA kinetics were positive indicators of oncologic outcomes. Compared with MAB + EBRT, MAB + EBRT + PPB remarkably improved PSA kinetics more pronouncedly: PSA nadir (1.3 ± 0.7 vs 0.11 ± 0.06 ng/mL); time of PSA decrease to nadir (7.5 ± 1.8 vs 3.2 ± 2.1 months); PSA doubling time (PSADT; 15.6 ± 4.2 vs 22.6 ± 6.1 months); decrease in PSA (84.6 ± 6.2% vs 95.8 ± 3.4%). Additionally, median times of several important oncologic events were prolonged in the MAB + EBRT + PPB group compared with the MAB + EBRT group: overall survival (OS; 12.3 vs 9.1 years, P < 0.001), biochemical recurrence-free survival (BRFS; 9.8 vs 6.5 years, P < 0.001), skeletal-related event (SRE; 10.4 vs 8.2 years, P < 0.001), and cytotoxic chemotherapy (CCT; 11.6 vs 8.8 years, P = 0.007).
MAB + EBRT + PPB is extremely effective in patients with localized, high-risk PCa, indicating that PPB may play a synergistic role in improving PSA kinetics and independently predicts oncologic outcomes.
评估放疗（RT）联合最大雄激素阻断（MAB）和前列腺特异性抗原（PSA）动力学在局限性高危前列腺癌（PCa）患者中的肿瘤学结果。
回顾性分析 2001 年至 2015 年间接受 RT+MAB 治疗的 320 例局限性 PCa 患者。所有患者均接受 36 个月的 MAB 治疗和 45Gy 盆腔照射，加剂量递增外照射放疗（DE-EBRT）至 76~81Gy（MAB+EBRT 组），或低剂量率前列腺永久近距离放射治疗（LDR-PPB）至 110Gy 用 I-125（MAB+EBRT+PPB 组）。
中位随访时间为 90 个月，范围为 12 至 186 个月；117（36.6%）和 203（63.4%）例患者分别接受 MAB+EBRT 和 MAB+EBRT+PPB 治疗。多因素 Cox 回归显示，PPB 方案和 PSA 动力学是肿瘤学结果的阳性指标。与 MAB+EBRT 相比，MAB+EBRT+PPB 显著改善 PSA 动力学更为明显：PSA 最低点（1.3±0.7 比 0.11±0.06ng/mL）；PSA 下降至最低点的时间（7.5±1.8 比 3.2±2.1 个月）；PSA 倍增时间（PSADT；15.6±4.2 比 22.6±6.1 个月）；PSA 下降（84.6±6.2%比 95.8±3.4%）。此外，与 MAB+EBRT 组相比，MAB+EBRT+PPB 组的几种重要肿瘤学事件的中位时间延长：总生存（OS；12.3 比 9.1 年，P<0.001）、生化无复发生存（BRFS；9.8 比 6.5 年，P<0.001）、骨骼相关事件（SRE；10.4 比 8.2 年，P<0.001）和细胞毒性化疗（CCT；11.6 比 8.8 年，P=0.007）。
MAB+EBRT+PPB 对局限性高危 PCa 患者非常有效，表明 PPB 可能在改善 PSA 动力学方面发挥协同作用，并独立预测肿瘤学结果。
