Urabe Fumihiko, Kimura Shoji, Tashiro Kojiro, Kido Masahito, Sasaki Hiroshi, Aoki Manabu, Kimura Takahiro, Miki Kenta, Egawa Shin
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan.
Prostate Cancer Prostatic Dis. 2021 Dec;24(4):976-985. doi: 10.1038/s41391-021-00372-x. Epub 2021 May 4.
The prognostic significance of PSA bounce following definitive radiation therapy remains controversial. To develop a sense of current opinion in this area, we performed a systematic search of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
In January 2021, we systematically searched PubMed, the Cochrane library, and Scopus for studies that compared patients who had localized prostate cancer with or without PSA bounce after definitive radiation therapy. Our objective was to evaluate the association of PSA bounce with biochemical recurrence-free survival, metastatic-free survival, cancer-specific survival, and overall survival, using multivariate Cox regression analysis.
A total of 8881 patients in 10 studies matched the selection criteria for the systematic review and meta-analysis. The number of patients with PSA bounce accounted for 2706 of all 8881 patients (30.5%). PSA bounce was associated with better biochemical recurrence-free survival after definitive radiation therapy (pooled HR: 0.62, 95% CI: 0.54-0.71). Subgroup analyses also showed that PSA bounce was independently associated with decreased risk for biochemical recurrence-free survival in prostate cancer patients treated with low dose rate brachytherapy alone (pooled HR: 0.38, 95% CI: 0.27-0.55) and external beam radiotherapy alone (pooled HR: 0.71, 95% CI: 0.57-0.87).
This meta-analysis indicated that PSA bounce after definitive radiation therapy is related to improved outcome in terms of biochemical failure in prostate cancer patients.
根治性放射治疗后前列腺特异性抗原（PSA）反弹的预后意义仍存在争议。为了解该领域的当前观点，我们根据系统评价和Meta分析的首选报告项目对文献进行了系统检索。
2021年1月，我们系统检索了PubMed、Cochrane图书馆和Scopus，以查找比较接受根治性放射治疗后出现或未出现PSA反弹的局限性前列腺癌患者的研究。我们的目的是使用多变量Cox回归分析评估PSA反弹与无生化复发生存、无转移生存、癌症特异性生存和总生存之间的关联。
10项研究中的8881例患者符合系统评价和Meta分析的入选标准。在所有8881例患者中，出现PSA反弹的患者有2706例（30.5%）。根治性放射治疗后，PSA反弹与更好的无生化复发生存相关（合并风险比：0.62，95%置信区间：0.54-0.71）。亚组分析还显示，PSA反弹与仅接受低剂量率近距离放射治疗（合并风险比：0.38，95%置信区间：0.27-0.55）和仅接受外照射放疗（合并风险比：0.71，95%置信区间：0.57-0.87）的前列腺癌患者无生化复发生存风险降低独立相关。
这项Meta分析表明，根治性放射治疗后PSA反弹与前列腺癌患者生化失败方面的预后改善有关。
