Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam, The Netherlands.
Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands.
J Urol. 2021 Apr;205(4):1100-1109. doi: 10.1097/JU.0000000000001437. Epub 2020 Nov 18.
We assessed predictors of short-term oncologic outcomes of patients who underwent salvage radiation therapy for biochemical recurrence after robot-assisted laparoscopic radical prostatectomy without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography.
We retrospectively analyzed 194 patients with biochemical recurrence after robot-assisted laparoscopic radical prostatectomy who underwent prostate specific membrane antigen positron emission tomography/computerized tomography prior to salvage radiation therapy. Patients with lymph node or distant metastases on restaging imaging or at the time of extended pelvic lymph node dissection during robot-assisted laparoscopic radical prostatectomy were excluded, as were patients who received androgen deprivation therapy during or prior to salvage radiation therapy. A multivariable logistic regression analysis was performed to assess predictors of treatment response, defined as prostate specific antigen value ≤0.1 ng/ml after salvage radiation therapy.
Overall treatment response after salvage radiation therapy was 75% (146/194 patients). On multivariable analysis, prostate specific antigen value at initiation of salvage radiation therapy (OR 0.42, 95% CI 0.27-0.62, p <0.001), pathological T stage (pT3a vs pT2 OR 0.28, 95% CI 0.11-0.69, p=0.006; pT3b vs pT2 OR 0.26, 95% CI 0.09-0.71, p=0.009) and local recurrent disease on imaging (OR 5.53, 95% CI 1.96-18.52, p=0.003) were predictors of treatment response.
Salvage radiation therapy in patients without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography showed a good overall treatment response of 75%. Higher treatment response rates were observed in patients with lower prostate specific antigen values at initiation of salvage radiation therapy, those with local recurrent disease on imaging and those with lower pathological T stage (pT2 vs pT3a/b).
我们评估了在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（PSMA-PET/CT）未见转移证据的情况下，接受挽救性放射治疗的机器人辅助腹腔镜根治性前列腺切除术后生化复发患者的短期肿瘤学结局的预测因素。
我们回顾性分析了 194 例机器人辅助腹腔镜根治性前列腺切除术后生化复发患者的资料，这些患者在接受挽救性放射治疗前均进行了 PSMA-PET/CT 检查。排除了影像学分期或机器人辅助腹腔镜根治性前列腺切除术中扩展盆腔淋巴结清扫时出现淋巴结或远处转移的患者，以及在挽救性放射治疗期间或之前接受雄激素剥夺治疗的患者。采用多变量逻辑回归分析来评估治疗反应的预测因素，定义为挽救性放射治疗后前列腺特异性抗原（PSA）值≤0.1ng/ml。
194 例患者中，挽救性放射治疗后的总治疗反应率为 75%（146/194 例）。多变量分析显示，挽救性放射治疗开始时的 PSA 值（OR 0.42，95%CI 0.27-0.62，p<0.001）、病理 T 分期（pT3a 与 pT2 相比，OR 0.28，95%CI 0.11-0.69，p=0.006；pT3b 与 pT2 相比，OR 0.26，95%CI 0.09-0.71，p=0.009）和影像学上的局部复发病灶（OR 5.53，95%CI 1.96-18.52，p=0.003）是治疗反应的预测因素。
在 PSMA-PET/CT 未见转移证据的患者中，挽救性放射治疗的总体治疗反应率为 75%，效果良好。在挽救性放射治疗开始时 PSA 值较低、影像学上有局部复发病灶和病理 T 分期较低（pT2 与 pT3a/b 相比）的患者中，治疗反应率更高。
