Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30629, Hannover, Germany.
Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.
BMC Cancer. 2020 Apr 29;20(1):362. doi: 10.1186/s12885-020-06883-5.
A substantial number of patients will develop further biochemical progression after radical prostatectomy (RP) and salvage radiotherapy (sRT). Recently published data using prostate-specific membrane antigen ligand positron emission tomography (PSMA - PET) for re-staging suggest that those recurrences are often located outside the prostate fossa and most of the patients have a limited number of metastases, making them amenable to metastasis-directed treatment (MDT).
We analyzed 78 patients with biochemical progression after RP and sRT from a retrospective European multicenter database and assessed the biochemical recurrence-free survival (bRFS; PSA < nadir + 0.2 ng/ml or no PSA decline) as well as the androgen deprivation therapy- free survival (ADT-FS) using Kaplan-Meier curves. Log-rank test and multivariate analysis was performed to determine influencing factors.
A total of 185 PSMA - PET positive metastases were detected and all lesions were treated with radiotherapy (RT). Concurrent ADT was prescribed in 16.7% (13/78) of patients. The median PSA level before RT was 1.90 ng/mL (range, 0.1-22.1) and decreased statistically significantly to a median PSA nadir level of 0.26 ng/mL (range, 0.0-12.25; p < 0.001). The median PSA level of 0.88 ng/mL (range, 0.0-25.8) at the last follow-up was also statistically significantly lower (p = 0.008) than the median PSA level of 1.9 ng/mL (range, 0.1-22.1) before RT. The median bRFS was 17.0 months (95% CI, 14.2-19.8). After 12 months, 55.3% of patients were free of biochemical progression. Multivariate analyses showed that concurrent ADT was the most important independent factor for bRFS (p = 0.01). The median ADT-FS was not reached and exploratory statistical analyses estimated a median ADT-FS of 34.0 months (95% CI, 16.3-51.7). Multivariate analyses revealed no significant parameters for ADT-FS.
RT as MDT based on PSMA - PET of all metastases of recurrent prostate cancer after RP and sRT represents a viable treatment option for well-informed and well-selected patients.
根治性前列腺切除术（RP）和挽救性放疗（sRT）后，大量患者会出现进一步的生化进展。最近发表的使用前列腺特异性膜抗原配体正电子发射断层扫描（PSMA-PET）进行再分期的数据表明，这些复发通常位于前列腺窝外，大多数患者的转移灶数量有限，使其能够接受转移灶定向治疗（MDT）。
我们分析了来自回顾性欧洲多中心数据库的 78 例 RP 和 sRT 后生化进展的患者，并使用 Kaplan-Meier 曲线评估生化无复发生存率（bRFS；PSA<最低值+0.2ng/ml 或 PSA 无下降）和雄激素剥夺治疗无复发生存率（ADT-FS）。对数秩检验和多变量分析用于确定影响因素。
共检测到 185 个 PSMA-PET 阳性转移灶，所有病灶均接受放疗（RT）治疗。16.7%（13/78）的患者同时接受 ADT 治疗。RT 前 PSA 中位水平为 1.90ng/mL（范围 0.1-22.1），统计学显著下降至 PSA 最低值中位水平 0.26ng/mL（范围 0.0-12.25；p<0.001）。最后一次随访时 PSA 中位水平为 0.88ng/mL（范围 0.0-25.8），也显著低于 RT 前 PSA 中位水平 1.9ng/mL（范围 0.1-22.1）（p=0.008）。中位 bRFS 为 17.0 个月（95%CI，14.2-19.8）。12 个月后，55.3%的患者生化无进展。多变量分析显示，同期 ADT 是 bRFS 的最重要独立因素（p=0.01）。中位 ADT-FS 未达到，探索性统计分析估计中位 ADT-FS 为 34.0 个月（95%CI，16.3-51.7）。多变量分析显示 ADT-FS 无显著参数。
基于 RP 和 sRT 后复发前列腺癌所有转移灶的 PSMA-PET 的 RT 作为 MDT，为知情和精选患者提供了一种可行的治疗选择。
