Lee Tae Hoon, Pyo Hongryull, Yoo Gyu Sang, Lee Hyun Moo, Jeon Seong Soo, Seo Seong Il, Jeong Byong Chang, Jeon Hwang Gyun, Sung Hyun Hwan, Kang Minyong, Song Wan, Chung Jae Hoon, Bae Bong Kyung, Park Won
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Prostate Int. 2023 Sep;11(3):173-179. doi: 10.1016/j.prnil.2023.07.002. Epub 2023 Jul 20.
This study aimed to evaluate the treatment outcomes and define the prostate-specific antigen (PSA) kinetics as potential prognostic factors in patients with intermediate- or high-risk localized prostate cancer (PCa) who underwent moderately hypofractionated radiation therapy.
The study retrospectively reviewed the medical records of 149 patients with intermediate- or high-risk localized PCa who underwent definitive radiation therapy (70 Gy in 28 fractions) without androgen deprivation therapy. Clinical outcomes were analyzed based on risk stratification (favorable-intermediate, unfavorable-intermediate, and high-risk). The biochemical failure rate (BFR) and clinical failure rate (CFR) were stratified based on the PSA nadir and the time to the PSA nadir to identify the prognostic effect of PSA kinetics. Acute and late genitourinary and gastrointestinal adverse events were analyzed.
Significant differences were observed in the BFR and CFR according to risk stratification. No recurrence was observed in the favorable intermediate-risk group. The 7-year BFR and CFR for the unfavorable intermediate-risk and high-risk groups were 19.2% and 9.8%, and 31.1% and 25.3%, respectively. Patients with a PSA nadir >0.33 ng/mL or a time to the PSA nadir <36 months had a significantly greater BFR and CFR. The crude rate of grade 3 late adverse events was 3.4% (genitourinary: 0.7%; gastrointestinal: 2.7%). No grade 4-5 adverse event was reported.
A significant difference in clinical outcomes was observed according to risk stratification. The PSA nadir and time to the PSA nadir were strongly associated with the BFR and CFR. Therefore, PSA kinetics during follow-up are important for predicting prognosis.
本研究旨在评估中度低分割放射治疗的中危或高危局限性前列腺癌（PCa）患者的治疗效果，并将前列腺特异性抗原（PSA）动力学定义为潜在的预后因素。
本研究回顾性分析了149例接受根治性放射治疗（28次分割，总剂量70Gy）且未接受雄激素剥夺治疗的中危或高危局限性PCa患者的病历。根据风险分层（有利中危、不利中危和高危）分析临床结果。根据PSA最低点及达到PSA最低点的时间对生化失败率（BFR）和临床失败率（CFR）进行分层，以确定PSA动力学的预后作用。分析急性和晚期泌尿生殖系统及胃肠道不良事件。
根据风险分层，BFR和CFR存在显著差异。有利中危组未观察到复发。不利中危组和高危组的7年BFR和CFR分别为19.2%和9.8%，以及31.1%和25.3%。PSA最低点>0.33 ng/mL或达到PSA最低点的时间<36个月的患者，其BFR和CFR显著更高。3级晚期不良事件的粗发生率为3.4%（泌尿生殖系统：0.7%；胃肠道：2.7%）。未报告4-5级不良事件。
根据风险分层观察到临床结果存在显著差异。PSA最低点及达到PSA最低点的时间与BFR和CFR密切相关。因此，随访期间的PSA动力学对预测预后很重要。
