Miyake Makito, Tanaka Nobumichi, Asakawa Isao, Owari Takuya, Hori Shunta, Morizawa Yosuke, Nakai Yasushi, Inoue Takeshi, Anai Satoshi, Torimoto Kazumasa, Hasegawa Masatoshi, Fujii Tomomi, Konishi Noboru, Fujimoto Kiyohide
Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Department of Radiation Oncology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Prostate Int. 2019 Jun;7(2):47-53. doi: 10.1016/j.prnil.2018.04.005. Epub 2018 May 5.
The clinical management and follow-up of patients with recurrent prostate cancer after salvage radiotherapy (SRT) has not yet been established, and no standardized definition of biochemical recurrence (BCR) after SRT exists. We compared the impact of applying three different definitions of BCR following SRT on patient outcomes and prognostication.
Patients who received salvage androgen-deprivation therapy before the completion of SRT were excluded. The data of 118 men who had undergone salvage radiation as monotherapy for BCR after radical prostatectomy were reviewed. In all patients, SRT comprised irradiation to the prostatic bed (70 Gy) using three-dimensional conformal radiotherapy techniques. Treatment outcomes, including BCR-free survival and prognostic factors, were analyzed and compared among three definitions: The Nara, Radiation Therapy Oncology Group (RTOG) 9601, and GETUG-AFU 16 definitions.
The BCR rate differed significantly among the applied definitions. Multivariate analyses identified the same four independent prognostic factors, including primary Gleason pattern 4 or 5, negative resection margin, prostate-specific antigen (PSA) level before SRT 0.5 or more, and PSA doubling time before SRT <6 months, using the RTOG 9601 and GETUG-AFU 16 definitions, whereas only two of the four factors were identified using the Nara definition. Although the results obtained using the RTOG 9601 and GETUG-AFU 16 definitions were similar, the prognostic value of the four factors differed. According to the RTOG 9601 definition of BCR, a negative resection margin on prostatectomy specimens and short PSA doubling time before SRT were associated with no subsequent response in PSA level.
The applied definition of BCR after SRT can influence the reported BCR-free rate and the potential prognostic factors. Establishment of the standardized definition is needed for the optimal management of patients with recurrent prostate cancer undergoing SRT.
挽救性放疗（SRT）后复发性前列腺癌患者的临床管理和随访尚未确立，且SRT后生化复发（BCR）尚无标准化定义。我们比较了SRT后应用三种不同BCR定义对患者结局和预后的影响。
排除在SRT完成前接受挽救性雄激素剥夺治疗的患者。回顾了118例前列腺癌根治术后接受挽救性放疗作为BCR单一疗法的男性患者的数据。所有患者均采用三维适形放疗技术对前列腺床进行照射（70 Gy）。分析并比较了三种定义下的治疗结局，包括无BCR生存期和预后因素：奈良定义、放射治疗肿瘤学组（RTOG）9601定义和GETUG-AFU 16定义。
所应用的定义之间BCR率差异显著。多变量分析确定了相同的四个独立预后因素，使用RTOG 9601和GETUG-AFU 16定义时包括原发 Gleason 模式4或5、阴性切缘、SRT前前列腺特异性抗原（PSA）水平≥0.5以及SRT前PSA倍增时间<6个月，而使用奈良定义时仅确定了四个因素中的两个。尽管使用RTOG 9601和GETUG-AFU 16定义获得的结果相似，但四个因素的预后价值不同。根据RTOG 9601的BCR定义，前列腺切除标本的阴性切缘和SRT前较短的PSA倍增时间与随后PSA水平无反应相关。
SRT后应用的BCR定义可影响报告的无BCR率和潜在的预后因素。对于接受SRT的复发性前列腺癌患者的最佳管理，需要建立标准化定义。
