Niwa Naoya, Matsumoto Kazuhiro, Nishiyama Toru, Yagi Yasuto, Ozu Choichiro, Nakamura Ken, Saito Shiro, Oya Mototsugu
Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Brachytherapy. 2018 Nov-Dec;17(6):899-905. doi: 10.1016/j.brachy.2018.08.018. Epub 2018 Sep 21.
To identify patients at extremely low risk of biochemical recurrence (BCR) of prostate cancer after low-dose-rate brachytherapy (LDR-BT) to determine when prostate-specific antigen (PSA) monitoring can be stopped.
We retrospectively reviewed clinicopathologic data of patients with prostate cancer who underwent LDR-BT between 2003 and 2011. Of 1569 patients reviewed, 689 (43.9%) received combination external beam radiotherapy, and 970 (61.8%) had neoadjuvant hormonal therapy. We stratified patients according to risk factors identified by multivariate analysis and assessed the factors for an association with BCR (defined as ≥2 ng/mL higher than the nadir).
The median followup was 96 months. Of 1531 patients who were BCR-free at 3 years after treatment, 76 subsequently developed BCR; of 1500 who were BCR-free at 5 years, 45 eventually had BCR. On multivariate analysis, independent risk factors for BCR were the National Comprehensive Cancer Network risk group at diagnosis and PSA levels at 3 or 5 years after radiotherapy. In the low-risk group, no patient with a PSA level ≤0.2 ng/mL at 3 years after radiotherapy subsequently developed BCR. In the intermediate-risk group, no patients with a PSA level ≤0.2 ng/mL at 5 years subsequently developed BCR.
The National Comprehensive Cancer Network risk group at diagnosis and PSA values at 3 and 5 years after LDR-BT are independently associated with a risk of later BCR. Using these two factors may help to select patients for whom PSA monitoring could be stopped because they have an extremely low risk of later BCR.
识别低剂量率近距离放射治疗（LDR-BT）后前列腺癌生化复发（BCR）风险极低的患者，以确定何时可以停止前列腺特异性抗原（PSA）监测。
我们回顾性分析了2003年至2011年间接受LDR-BT的前列腺癌患者的临床病理数据。在1569例接受回顾的患者中，689例（43.9%）接受了外照射放疗联合治疗，970例（61.8%）接受了新辅助激素治疗。我们根据多变量分析确定的风险因素对患者进行分层，并评估与BCR（定义为比最低点高≥2 ng/mL）相关的因素。
中位随访时间为96个月。在治疗后3年无BCR的1531例患者中，76例随后发生了BCR；在5年无BCR的1500例患者中，45例最终发生了BCR。多变量分析显示，BCR的独立风险因素为诊断时的美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）风险组以及放疗后3年或5年时的PSA水平。在低风险组中，放疗后3年时PSA水平≤0.2 ng/mL的患者均未随后发生BCR。在中风险组中，5年时PSA水平≤0.2 ng/mL的患者均未随后发生BCR。
诊断时的NCCN风险组以及LDR-BT后3年和5年时的PSA值与后期BCR风险独立相关。利用这两个因素可能有助于选择那些因后期BCR风险极低而可以停止PSA监测的患者。
