MVZ Klinikum Esslingen GmbH, Fachbereich Strahlentherapie, Esslingen, Germany.
Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany.
Prostate Cancer Prostatic Dis. 2019 May;22(2):344-349. doi: 10.1038/s41391-018-0112-3. Epub 2018 Nov 28.
For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiotherapy (SRT) offers a second chance of cure. European guidelines (EAU) recommend SRT at a PSA < 0.5 ng/ml. We analyze the efficacy of SRT given according to this recommendation and investigate the predictive power of the post-SRT PSA nadir.
Between 1998 and 2013, 301 patients of two university hospitals received SRT at a PSA < 0.5 ng/ml (median 0.192 ng/ml, IQR 0.110-0.300). Patients, who previously received androgen deprivation therapy, were excluded. All patients had 3D-conformal RT or intensity-modulated radiotherapy (IMRT, n = 59) (median 66.6 Gy). The median follow-up was 5.9 years. Progression and overall survival were the endpoints.
After SRT, 252 patients re-achieved an undetectable PSA. In univariate analysis, pre-RP PSA ≥ 10 ng/ml, pT3-4, Gleason score (GS) 7-10 or 8-10, negative surgical margins, post-RP PSA ≥ 0.1 ng/ml, pre-SRT PSA ≥ 0.2 ng/ml and post-SRT PSA nadir ≥ 0.1 ng/ml correlated unfavorably with post-SRT progression. In a multivariable Cox model, pT3-4, GS 7-10, negative margins and a pre-SRT PSA ≥ 0.2 ng/ml were significant risk factors. If the post-SRT PSA was added to the analysis, it dominated the outcome (HR = 9.00). Of the patients with a pre-SRT PSA < 0.2 ng/ml, only 9% failed re-achieving an undetectable PSA. Overall survival in these patients was 98% after 5.9 years compared to 91% in patients with higher pre-SRT PSA (Logrank p = 0.004).
SRT at a PSA < 0.2 ng/ml correlates significantly with achieving a post-SRT undetectable PSA (<0.1 ng/ml) and subsequently with improved freedom from progression. Given these overall favorable outcomes, whether additional androgen deprivation therapy is required for these men requires further study.
对于根治性前列腺切除术（RP）后复发的前列腺癌患者，挽救性放疗（SRT）提供了治愈的第二次机会。欧洲指南（EAU）建议 PSA<0.5ng/ml 时进行 SRT。我们分析了按照这一建议进行 SRT 的疗效，并研究了 SRT 后 PSA 最低点的预测能力。
1998 年至 2013 年间，两所大学医院的 301 例患者在 PSA<0.5ng/ml（中位数 0.192ng/ml，IQR 0.110-0.300）时接受 SRT。排除了先前接受雄激素剥夺治疗的患者。所有患者均接受 3D 适形放疗或调强放疗（IMRT，n=59）（中位数 66.6Gy）。中位随访时间为 5.9 年。进展和总生存是终点。
SRT 后，252 例患者 PSA 再次降至不可检测水平。单因素分析显示，RP 前 PSA≥10ng/ml、pT3-4、Gleason 评分（GS）7-10 或 8-10、阴性手术切缘、RP 后 PSA≥0.1ng/ml、RP 前 PSA≥0.1ng/ml 和 SRT 后 PSA 最低点≥0.1ng/ml 与 SRT 后进展不良相关。多变量 Cox 模型中，pT3-4、GS 7-10、阴性切缘和 SRT 前 PSA≥0.2ng/ml 是显著的危险因素。如果将 SRT 后的 PSA 纳入分析，它将主导结果（HR=9.00）。在 SRT 前 PSA<0.2ng/ml 的患者中，只有 9%未能再次达到不可检测的 PSA。这些患者在 5.9 年后的总生存率为 98%，而 SRT 前 PSA 较高的患者为 91%（Logrank p=0.004）。
SRT 在 PSA<0.2ng/ml 时与 SRT 后达到不可检测的 PSA（<0.1ng/ml）显著相关，随后与进展无显著相关。鉴于这些总体良好的结果，这些男性是否需要额外的雄激素剥夺治疗需要进一步研究。
