Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
Eur Urol. 2020 Aug;78(2):155-160. doi: 10.1016/j.eururo.2020.04.068. Epub 2020 May 19.
Focal therapy (FT) for prostate cancer (PCa) is emerging as a novel therapeutic approach for patients with low- to intermediate-risk disease, in order to provide acceptable oncological control, whilst avoiding the side effects of radical treatment. Evidence regarding the ideal follow-up strategy and the significance of prostate-specific antigen (PSA) kinetics after treatment is needed. In this study, we aimed to assess the value of the percentage of PSA reduction (%PSA reduction) after FT in predicting the likelihood of any additional treatment or any radical treatment. We retrospectively analysed a multicentre cohort of 703 men receiving FT for low- and intermediate-risk PCa. Overall, the rates of any additional treatment and any radical treatment were 30% and 13%, respectively. The median follow-up period was 41 mo. The median %PSA reduction after FT was 73%. At Cox multivariable analysis, %PSA reduction was an independent predictor of any additional treatment (hazard ratio [HR]: 0.96; p < 0.001) and radical treatment (HR: 0.97; p < 0.001) after FT. For %PSA reduction of>90%, the probability of any additional treatment within 5 yr was 20%. Conversely, for %PSA reduction of <10%, the probability of receiving any additional treatment within 5 yr was roughly 70%. This study is the first to assess the role of %PSA reduction in the largest multicentre cohort of men receiving FT for PCa. Given the lack of standardised follow-up strategies in the FT field, the use of the %PSA reduction should be considered. PATIENT SUMMARY: The percentage of prostate-specific antigen reduction is a useful tool to assess men following focal therapy (FT). It can assist the urologist in setting up an appropriate follow-up and during post-FT patient counselling.
前列腺癌（PCa）的局部治疗（FT）作为一种治疗低危到中危疾病患者的新方法，正在逐渐兴起，以便提供可接受的肿瘤控制效果，同时避免根治性治疗的副作用。需要有证据来证明治疗后理想的随访策略以及前列腺特异性抗原（PSA）动力学的意义。在这项研究中，我们旨在评估 FT 后 PSA 降低百分比（%PSA 降低）在预测是否需要额外治疗或任何根治性治疗的可能性方面的价值。我们回顾性分析了接受 FT 治疗低危到中危 PCa 的 703 名男性的多中心队列。总体而言，任何额外治疗和任何根治性治疗的比例分别为 30%和 13%。中位随访时间为 41 个月。FT 后 PSA 降低的中位数为 73%。在 Cox 多变量分析中，%PSA 降低是 FT 后任何额外治疗（风险比 [HR]：0.96；p < 0.001）和根治性治疗（HR：0.97；p < 0.001）的独立预测因子。对于>90%的 PSA 降低，5 年内需要任何额外治疗的概率为 20%。相反，对于 PSA 降低<10%的患者，5 年内需要任何额外治疗的概率约为 70%。这是第一项评估在接受 FT 治疗 PCa 的最大多中心队列中 PSA 降低百分比作用的研究。鉴于 FT 领域缺乏标准化的随访策略，应考虑使用 PSA 降低百分比。患者总结：PSA 降低百分比是评估接受局部治疗（FT）后男性的有用工具。它可以帮助泌尿科医生制定适当的随访计划，并在 FT 后患者咨询期间提供帮助。
