Kano Hiroshi, Kadono Yoshifumi, Naito Renato, Makino Tomoyuki, Iwamoto Hiroaki, Yaegashi Hiroshi, Kawaguchi Shohei, Nohara Takahiro, Shigehara Kazuyoshi, Izumi Kouji, Mizokami Atsushi
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan.
Department of Nephrology and Urology, Japanese Red Cross Fukui Hospital, Fukui 918-8501, Japan.
Cancers (Basel). 2024 Mar 27;16(7):1304. doi: 10.3390/cancers16071304.
The efficacy of intermittent androgen deprivation therapy (ADT) for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) is unknown, and its usefulness in Japanese practice needs to be investigated.
We conducted a retrospective analysis of 85 patients who underwent RARP and were selected for intermittent ADT for postoperative recurrence at Kanazawa University Hospital between 2009 and 2019. Intermittent ADT was administered for 2 years. If prostate-specific antigen levels increased post-treatment, intermittent ADT was reinitiated. The median follow-up period was 47 months.
The 73 patients had completed the initial course of ADT, and 12 were under initial ADT. The 5-year castration-resistant prostate-cancer-free survival rates, cancer-specific survival, and overall survival were 92.7%, 98.3%, and 94.7%, respectively. A subgroup analysis of 69 patients who completed intermittent ADT was conducted to evaluate the BCR rate following initial ADT. The 5-year BCR-free survival rate was 53.2%. Multivariate analysis identified testosterone ≤ 0.03 ng/mL during ADT as the sole predictor of BCR after ADT.
Salvage intermittent ADT may be an effective treatment option for BCR after RARP. In addition, it would be useful to confirm strong testosterone suppression as a criterion for transition to intermittent therapy.
机器人辅助根治性前列腺切除术（RARP）后，间歇性雄激素剥夺疗法（ADT）对生化复发（BCR）的疗效尚不清楚，其在日本临床实践中的实用性有待研究。
我们对2009年至2019年在金泽大学医院接受RARP并因术后复发而选择间歇性ADT的85例患者进行了回顾性分析。间歇性ADT治疗2年。如果治疗后前列腺特异性抗原水平升高，则重新开始间歇性ADT。中位随访期为47个月。
73例患者完成了初始ADT疗程，12例仍在接受初始ADT治疗。5年去势抵抗性前列腺癌无进展生存率、癌症特异性生存率和总生存率分别为92.7%、98.3%和94.7%。对69例完成间歇性ADT的患者进行亚组分析，以评估初始ADT后的BCR率。5年无BCR生存率为53.2%。多变量分析确定ADT期间睾酮≤0.03 ng/mL是ADT后BCR的唯一预测因素。
挽救性间歇性ADT可能是RARP后BCR的有效治疗选择。此外，确认强效睾酮抑制作为转为间歇性治疗的标准可能会有帮助。
