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. 2023 Aug;28(8):1092-1100. doi: 10.1007/s10147-023-02359-1. Epub 2023 May 25.
Although the optimal management of locally advanced prostate cancer (PCa) remains unclear, local definitive therapy, thus combined radiotherapy and androgen deprivation, is one option. We evaluated the long-term outcomes of patients with locally advanced PCa who underwent high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT).
We retrospectively analyzed 173 patients with locally advanced PCa (cT3a-4N0-1M0) who underwent HDR-BT and EBRT. We employed Cox's proportional hazards models to identify pre-treatment predictors of oncological outcomes. Treatment outcomes (biochemical recurrence-free survival [BCRFS], clinical progression-free survival [CPFS], and castration-resistant prostate cancer-free survival [CRPCFS] were compared according to the combination of the pre-treatment predictors.
The 5-year BCRFS, CPFS, and CRPCFS rates were 78.5, 91.7, and 94.4% respectively; there were two PCa deaths. Multivariate analysis revealed that the clinical T stage (cT3b and cT4) and Grade Group (GG) 5 status were independent risk factors for poor BCRFS, CPFS, and CRPCFS. In the GG ≤ 4 group, the Kaplan-Meier curves for BCRFS, CPFS, and CRPCFS revealed excellent outcomes. However, in the GG5 group, patients with cT3b and cT4 PCa evidenced significantly poorer oncological outcomes than those with cT3a PCa.
The clinical T stage and GG status were significantly prognostic of oncological outcomes in patients with locally advanced PCa. In patients of GG ≤ 4 PCa, HDR-BT was effective even in patients with cT3b or cT4 PCa. However, in patients with GG5 PCa, careful monitoring is essential, particularly of patients with cT3b or cT4 PCa.
尽管局部晚期前列腺癌（PCa）的最佳治疗方法仍不明确，但局部根治性治疗，即联合放疗和雄激素剥夺治疗，是一种选择。我们评估了接受高剂量率近距离放射治疗（HDR-BT）和外部束放射治疗（EBRT）的局部晚期 PCa 患者的长期结果。
我们回顾性分析了 173 例局部晚期 PCa（cT3a-4N0-1M0）患者，这些患者接受了 HDR-BT 和 EBRT。我们采用 Cox 比例风险模型来确定肿瘤学结果的治疗前预测因素。根据治疗前预测因素的组合，比较了治疗结果（生化无复发生存率[BCRFS]、临床无进展生存率[CPFS]和去势抵抗性前列腺癌无复发生存率[CRPCFS]）。
5 年 BCRFS、CPFS 和 CRPCFS 率分别为 78.5%、91.7%和 94.4%；有 2 例 PCa 死亡。多变量分析显示，临床 T 分期（cT3b 和 cT4）和 GG5 状态是 BCRFS、CPFS 和 CRPCFS 不良的独立危险因素。在 GG≤4 组中，BCRFS、CPFS 和 CRPCFS 的 Kaplan-Meier 曲线显示出良好的结果。然而，在 GG5 组中，cT3b 和 cT4 PCa 患者的肿瘤学结果明显比 cT3a PCa 患者差。
临床 T 分期和 GG 状态是局部晚期 PCa 患者肿瘤学结果的显著预后因素。在 GG≤4 PCa 患者中，即使是 cT3b 或 cT4 PCa 患者，HDR-BT 也是有效的。然而，在 GG5 PCa 患者中，需要仔细监测，特别是对 cT3b 或 cT4 PCa 患者。
