Darwis Narisa Dewi Maulany, Oike Takahiro, Kawamura Hidemasa, Kawahara Masahiro, Kubo Nobuteru, Sato Hiro, Miyasaka Yuhei, Katoh Hiroyuki, Ishikawa Hitoshi, Matsui Hiroshi, Miyazawa Yoshiyuki, Ito Kazuto, Suzuki Kazuhiro, Gondhowiardjo Soehartati, Nakano Takashi, Ohno Tatsuya
Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan.
Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia - dr. Cipto Mangunkusumo Hospital, Jl. P. Diponegoro no. 71, Jakarta 10430, Indonesia.
Cancers (Basel). 2020 Mar 4;12(3):589. doi: 10.3390/cancers12030589.
This study aimed to first elucidate prostate-specific antigen (PSA) kinetics in prostate cancer patients treated with carbon ion radiotherapy (CIRT). From 2010 to 2015, 131 patients with prostate adenocarcinoma treated with CIRT (57.6 Gy relative biological effectiveness (RBE) in 16 fractions) alone were recruited. PSA was measured at 1, 2, 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, and 60 months post-CIRT. PSA bounce was defined as PSA increase over a cutoff followed by spontaneous decrease to or below the pre-bounce nadir. PSA failure was determined using the Phoenix criteria (nadir + 2.0 ng/mL). As a result, non-failure-associated temporary increase in PSA exhibited two distinct patterns, namely a classical bounce and a surge at one month. PSA bounce of ³0.2 ng/mL was observed in 55.7% of the patients. Bounce amplitude was <2.0 ng/mL in 97.6% of cases. Bounce occurred significantly earlier than PSA failure. Younger age was a significant predictor of bounce occurrence. Bounce positivity was a significant predictor of favorable 5-year PSA failure-free survival. Meanwhile, a PSA surge of ³0.2 ng/mL was observed in 67.9% of patients. Surge amplitude was significantly larger than bounce amplitude. Larger prostate volume was a significant predictor of PSA surge occurrence. PSA surge positivity did not significantly predict PSA failure. In summary, PSA bounce was distinguishable from PSA failure with regard to timing of occurrence and amplitude (earlier and lower for bounce, respectively). These data are useful for post-CIRT surveillance of prostate cancer patients.
本研究旨在首先阐明接受碳离子放疗（CIRT）的前列腺癌患者的前列腺特异性抗原（PSA）动力学。2010年至2015年，招募了131例仅接受CIRT（16分次，相对生物效应（RBE）为57.6 Gy）治疗的前列腺腺癌患者。在CIRT后1、2、3、6、9、12、15、18、21、24、30、36、42、48、54和60个月测量PSA。PSA反弹定义为PSA超过临界值后升高，随后自发下降至反弹前最低点或以下。使用Phoenix标准（最低点+2.0 ng/mL）确定PSA失败。结果，与失败无关的PSA暂时升高表现出两种不同模式，即经典反弹和1个月时的激增。55.7%的患者观察到PSA反弹³0.2 ng/mL。97.6%的病例反弹幅度<2.0 ng/mL。反弹明显早于PSA失败发生。较年轻的年龄是反弹发生的显著预测因素。反弹阳性是5年无PSA失败生存良好的显著预测因素。同时，67.9%的患者观察到PSA激增³0.2 ng/mL。激增幅度明显大于反弹幅度。较大的前列腺体积是PSA激增发生的显著预测因素。PSA激增阳性不能显著预测PSA失败。总之，PSA反弹在发生时间和幅度方面与PSA失败有区别（分别为反弹更早、幅度更低）。这些数据有助于对前列腺癌患者进行CIRT后监测。
