Saito Takafumi, Matsumoto Kazuhiro, Kosaka Takeo, Yasumizu Yota, Tanaka Nobuyuki, Takeda Toshikazu, Morita Shinya, Mizuno Ryuichi, Asanuma Hiroshi, Oya Mototsugu
Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Int J Clin Oncol. 2023 May;28(5):707-715. doi: 10.1007/s10147-023-02322-0. Epub 2023 Mar 17.
The treatment strategy for prostate-specific antigen (PSA) progression in patients who receive salvage radiation therapy (RT) for biochemical recurrence (BCR) after radical prostatectomy (RP) is salvage androgen deprivation therapy (ADT). However, its optimal timing is highly controversial.
The study sample consisted of 77 men who underwent RP, received salvage RT against BCR, and underwent salvage ADT for PSA progression. The endpoint of this study was development to castration-resistant prostate cancer (CRPC), from the start of salvage RT.
The median follow-up time was 9.5 years, and 20 patients experienced CRPC. The multivariable analysis identified PSA-doubling time (PSA-DT) ≤ 12 months (hazard ratio, 3.5) and seminal vesicle invasion (SVI) (hazard ratio, 4.4) as independent risk factors. We defined the high-risk and low-risk groups as those with one or two risk factors and no risk factors, respectively. In the high-risk group, a significant difference in time to CRPC was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 8) and at > 1.0 ng/mL (n = 27) (10-year non-CRPC rate: 100.0% vs. 46.3%, respectively). In contrast, in the low-risk group, no significant difference in CRPC-free survival was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 14) and at > 1.0 ng/mL (n = 28) (10-year non-CRPC rate: 86.4% vs. 80.8%, respectively).
In high-risk patients (PSA-DT ≤ 12 months and/or SVI), salvage ADT for PSA progression after salvage RT should be started before the PSA levels exceed 1.0 ng/mL.
对于根治性前列腺切除术（RP）后因生化复发（BCR）接受挽救性放射治疗（RT）的患者，前列腺特异性抗原（PSA）进展的治疗策略是挽救性雄激素剥夺治疗（ADT）。然而，其最佳时机存在高度争议。
研究样本包括77名接受RP、因BCR接受挽救性RT并因PSA进展接受挽救性ADT的男性。本研究的终点是从挽救性RT开始至去势抵抗性前列腺癌（CRPC）的发生。
中位随访时间为9.5年，20例患者发生CRPC。多变量分析确定PSA倍增时间（PSA-DT）≤12个月（风险比，3.5）和精囊侵犯（SVI）（风险比，4.4）为独立危险因素。我们将高危组和低危组分别定义为有一个或两个危险因素和无危险因素的患者。在高危组中，PSA≤1.0 ng/mL（n = 8）和>1.0 ng/mL（n = 27）时接受挽救性ADT的患者在至CRPC的时间上存在显著差异（10年无CRPC率：分别为100.0%和46.3%）。相比之下，在低危组中，PSA≤1.0 ng/mL（n = 14）和>1.0 ng/mL（n = 28）时接受挽救性ADT的患者在无CRPC生存方面无显著差异（10年无CRPC率：分别为86.4%和80.8%）。
在高危患者（PSA-DT≤12个月和/或SVI）中，挽救性RT后因PSA进展进行的挽救性ADT应在PSA水平超过1.0 ng/mL之前开始。
