Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Clin Oncol (R Coll Radiol). 2020 Mar;32(3):156-162. doi: 10.1016/j.clon.2020.01.003.
For patients experiencing biochemical recurrence in the absence of distant metastasis, salvage radiotherapy (SRT) with or without androgen deprivation therapy (ADT) is currently the only possible curative treatment option. Prostate-specific antigen (PSA) monitoring and the selected use of SRT has some advantages when compared with adjuvant radiotherapy. The most important one is avoidance of a potential overtreatment of patients who would never have disease progression, even in the presence of high-risk pathological features. The identification of a specific PSA cut-off seems to be incorrect. In patients with more adverse pathological features, early SRT administered at the very first sign of a PSA rise granted better disease control. Dose-intensified SRT is feasible and well tolerated with no significant difference in grade 2 or more acute and late toxicity. At least 66 Gy must be given in the salvage setting. ADT has a radio-sensitising effect on the radiotherapy by inhibiting the repair of DNA double-strand breaks. The use of ADT in the salvage setting results in a better oncological outcome. Hormonal therapy is associated with a decrease in quality of life and side-effects depending on the duration of hormone therapy. The oncological benefit of hormone therapy duration depends on their clinical and pathological characteristics. 68-Ga-prostate-specific membrane antigen positron emission tomography-computed tomography is the gold standard in staging prostate cancer patients with biochemical persistence or recurrence after radical prostatectomy. The implementation of 18F-labelled PSMA tracers can provide a further improvement.
对于没有远处转移的生化复发患者，挽救性放疗（SRT）联合或不联合雄激素剥夺治疗（ADT）是目前唯一可能的治愈性治疗选择。与辅助放疗相比，前列腺特异性抗原（PSA）监测和 SRT 的选择性使用具有一些优势。最重要的是，避免了对即使存在高危病理特征但永远不会发生疾病进展的患者进行潜在的过度治疗。确定特定的 PSA 截止值似乎不正确。在具有更多不利病理特征的患者中，在 PSA 升高的最初迹象时即给予早期 SRT 可更好地控制疾病。剂量强化 SRT 是可行的，并且耐受性良好，在 2 级或更高级别的急性和晚期毒性方面没有显著差异。挽救性放疗中至少需要给予 66 Gy。ADT 通过抑制 DNA 双链断裂的修复对放疗具有放射增敏作用。在挽救性放疗中使用 ADT 可获得更好的肿瘤学结果。激素治疗会降低生活质量并产生副作用，具体取决于激素治疗的持续时间。激素治疗持续时间的肿瘤学获益取决于其临床和病理特征。68-Ga-前列腺特异性膜抗原正电子发射断层扫描-计算机断层扫描是根治性前列腺切除术后生化持续或复发的前列腺癌患者分期的金标准。18F 标记的 PSMA 示踪剂的实施可以提供进一步的改善。
