Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA.
Eur Urol. 2021 Aug;80(2):142-146. doi: 10.1016/j.eururo.2021.04.035. Epub 2021 May 10.
The natural history of radiorecurrent high-risk prostate cancer (HRPCa) is not well-described. To better understand its clinical course, we evaluated rates of distant metastases (DM) and prostate cancer-specific mortality (PCSM) in a cohort of 978 men with radiorecurrent HRPCa who previously received either external beam radiation therapy (EBRT, n = 654, 67%) or EBRT + brachytherapy (EBRT + BT, n = 324, 33%) across 15 institutions from 1997 to 2015. In men who did not die, median follow-up after treatment was 8.9 yr and median follow-up after biochemical recurrence (BCR) was 3.7 yr. Local and systemic therapy salvage, respectively, were delivered to 21 and 390 men after EBRT, and eight and 103 men after EBRT + BT. Overall, 435 men developed DM, and 248 were detected within 1 yr of BCR. Measured from time of recurrence, 5-yr DM rates were 50% and 34% after EBRT and EBRT + BT, respectively. Measured from BCR, 5-yr PCSM rates were 27% and 29%, respectively. Interval to BCR was independently associated with DM (p < 0.001) and PCSM (p < 0.001). These data suggest that radiorecurrent HRPCa has an aggressive natural history and that DM is clinically evident early after BCR. These findings underscore the importance of further investigations into upfront risk assessment and prompt systemic evaluation upon recurrence in HRPCa. PATIENT SUMMARY: High-risk prostate cancer that recurs after radiation therapy is an aggressive disease entity and spreads to other parts of the body (metastases). Some 60% of metastases occur within 1 yr. Approximately 30% of these patients die from their prostate cancer.
放射性复发高危前列腺癌（HRPCa）的自然史尚未得到充分描述。为了更好地了解其临床病程，我们评估了 978 例先前接受过外束放射治疗（EBRT，n=654，67%）或 EBRT+近距离放射治疗（EBRT+BT，n=324，33%）的放射性复发 HRPCa 男性患者的远处转移（DM）和前列腺癌特异性死亡率（PCSM）的发生率，这些患者来自 1997 年至 2015 年间的 15 个机构。在未死亡的患者中，治疗后中位随访时间为 8.9 年，生化复发（BCR）后中位随访时间为 3.7 年。EBRT 后分别对 21 名和 390 名患者进行了局部和全身挽救性治疗，EBRT+BT 后分别对 8 名和 103 名患者进行了治疗。总体而言，435 名患者发生 DM，248 名患者在 BCR 后 1 年内被检测到。从复发时间开始测量，EBRT 和 EBRT+BT 后 5 年 DM 发生率分别为 50%和 34%。从 BCR 开始测量，5 年 PCSM 发生率分别为 27%和 29%。BCR 间隔时间与 DM（p<0.001）和 PCSM（p<0.001）独立相关。这些数据表明，放射性复发 HRPCa 具有侵袭性的自然史，且在 BCR 后早期即可发生 DM。这些发现强调了进一步研究 HRPCa 中复发时的风险评估和系统评估的重要性。患者总结：放射治疗后复发的高危前列腺癌是一种侵袭性疾病实体，会扩散到身体的其他部位（转移）。大约 60%的转移发生在 1 年内。这些患者中约有 30%死于前列腺癌。
