Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan.
Int J Clin Oncol. 2022 Feb;27(2):411-417. doi: 10.1007/s10147-021-02053-0. Epub 2021 Oct 22.
Prostate-specific antigen (PSA) bounce after definitive radiotherapy has been reported as a predictor of improved biochemical recurrence-free survival (BCRFS). We revisited this phenomenon to confirm its clinical impact on oncological outcomes in patients with long-term follow-up who were free of biochemical recurrence (BCR) at least 3 years after treatment.
A total of 541 patients with localized, intermediate-risk prostate cancer underwent low-dose rate brachytherapy with iodine-125 seeds with or without supplemental external beam radiotherapy in combination. Neoadjuvant hormonal therapy was administered to 273 patients (50.5%) with a median duration of 3 months (range 1-108 months). PSA bounce was defined as ≥ 0.2 ng/ml increase above the interval PSA nadir, followed by a decrease below that value.
The median age was 69 years (range 49-90 years). The median follow-up duration was 102 months (range 36-205 months). One-hundred and fifty patients (27.7%) had PSA bounce with a median magnitude of 0.47 ng/ml (range 0.2-3.19 ng/ml). Age was significantly associated with the occurrence of PSA bounce [age: hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.93-0.98]. It was found to be independently associated with a decreased risk for BCR (HR 0.29; 95% CI 0.12-0.69) and clinical progression (HR 0.44; 95% CI 0.95-0.98).
PSA bounce indicated a favorable BCRFS and clinical progression-free survival in patients who had been free of BCR for at least 3 years after definitive radiotherapy.
根治性放疗后前列腺特异性抗原（PSA）反弹已被报道为改善生化无复发生存率（BCRFS）的预测指标。我们重新研究了这一现象，以确认其对治疗后至少 3 年无生化复发（BCR）的患者的长期随访中的肿瘤学结局的临床影响。
共 541 例局限性、中危前列腺癌患者接受低剂量率碘 125 种子近距离放疗联合或不联合补充外部束放疗。273 例患者（50.5%）接受新辅助激素治疗，中位持续时间为 3 个月（范围 1-108 个月）。PSA 反弹定义为 PSA 最低点后 PSA 升高≥0.2ng/ml，随后 PSA 降至最低点以下。
中位年龄为 69 岁（范围 49-90 岁）。中位随访时间为 102 个月（范围 36-205 个月）。150 例患者（27.7%）出现 PSA 反弹，中位幅度为 0.47ng/ml（范围 0.2-3.19ng/ml）。年龄与 PSA 反弹的发生显著相关[年龄：危险比（HR）0.95，95%置信区间（CI）0.93-0.98]。发现其与 BCR 风险降低独立相关（HR 0.29；95%CI 0.12-0.69）和临床进展（HR 0.44；95%CI 0.95-0.98）。
在根治性放疗后至少 3 年无 BCR 的患者中，PSA 反弹预示着 BCRFS 和临床无进展生存率良好。
