Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan;
Anticancer Res. 2023 Jul;43(7):3135-3143. doi: 10.21873/anticanres.16486.
BACKGROUND/AIM: A recent clinical trial indicated the usefulness of local radiation therapy of the prostate in patients with low-volume metastatic prostate cancer. High-dose-rate brachytherapy (HDR-BT) is used mainly for high-risk, localized, and locally advanced cases. However, few studies exist on the efficacy of HDR-BT and external beam radiation therapy (EBRT) for metastatic prostate cancer.
We conducted a retrospective analysis of 39 patients diagnosed with regional lymph node metastasis and/or a limited number of metastases who underwent HDR-BT and EBRT with long-term androgen deprivation therapy. We utilized Cox's proportional hazards models to identify predictors of oncological outcomes. Treatment outcomes, including biochemical recurrence-free survival (BCRFS), clinical progression-free survival (CPFS), and castration-resistant prostate cancer-free survival (CRPCFS), were compared according to the clinical stage.
The median follow-up duration was 49 months (range=23-136 months). The 5-year BCRFS, CPFS, CRPCFS, and cancer-specific survival rates were 62.2%, 67.2%, 83.2%, and 93.4%, respectively. Based on Kaplan-Meier analysis, N1M0 and N0-1M1b showed favorable outcomes compared with N1M1a. Multivariate analysis revealed that N1M1a prostate cancer was an independent risk factor for poor BCRFS, CPFS, and CRPCFS.
HDR-BT and EBRT with androgen deprivation therapy is a feasible approach for patients with newly diagnosed regional and low-metastatic-burden prostate cancer. However, in our cohort M1a prostate cancer had significantly inferior outcomes. A well-controlled prospective study is imperative to confirm our results.
背景/目的：最近的一项临床试验表明，对于低体积转移性前列腺癌患者，前列腺局部放射治疗是有用的。高剂量率近距离放射治疗（HDR-BT）主要用于高危、局限性和局部进展性病例。然而，关于转移性前列腺癌的 HDR-BT 和外照射放射治疗（EBRT）的疗效研究较少。
我们对 39 例诊断为区域淋巴结转移和/或少数转移的患者进行了回顾性分析，这些患者接受了 HDR-BT 和 EBRT 联合长期雄激素剥夺治疗。我们利用 Cox 比例风险模型来确定肿瘤学结果的预测因素。根据临床分期比较了治疗结果，包括生化无复发生存率（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）。
中位随访时间为 49 个月（范围=23-136 个月）。5 年 BCRFS、CPFS、CRPCFS 和癌症特异性生存率分别为 62.2%、67.2%、83.2%和 93.4%。基于 Kaplan-Meier 分析，N1M0 和 N0-1M1b 与 N1M1a 相比具有较好的结果。多变量分析显示，N1M1a 前列腺癌是 BCRFS、CPFS 和 CRPCFS 不良的独立危险因素。
HDR-BT 和 EBRT 联合雄激素剥夺治疗是新诊断的局部和低转移负荷前列腺癌患者的一种可行方法。然而，在我们的队列中，M1a 前列腺癌的结果明显较差。需要进行良好对照的前瞻性研究来证实我们的结果。
