Nishino Takato, Yamamoto Shinya, Numao Noboru, Komai Yoshinobu, Oguchi Tomohiko, Yasuda Yosuke, Fujiwara Ryo, Yuasa Takeshi, Yonese Junji
Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Cancer Diagn Progn. 2024 Sep 1;4(5):646-651. doi: 10.21873/cdp.10376. eCollection 2024 Sep-Oct.
BACKGROUND/AIM: To examine the specific time frame and identify associated risk factors from commencement of hormonal therapy to the onset of castration-resistant prostate cancer among patients who have developed biochemical recurrence following radical prostatectomy.
We retrospectively reviewed the records of 92 patients who developed biochemical recurrence and received hormonal therapy as initial salvage treatment after radical prostatectomy for high-risk localized prostate cancer from 2005 to 2021. The castration-resistant prostate cancer-free survival rates from the commencement of salvage hormonal therapy were analyzed using log-rank methods. Cox proportional hazard regression was performed to analyze the risk factors associated with acquiring castration resistance. The patients were stratified based on those risk factors.
During a median follow-up duration of 57 months, 24 (26.1%) patients developed castration-resistant prostate cancer. The 5- and 10-year castration-resistant prostate cancer-free survival rates were 73.6% and 54.5%, respectively. A multivariate analysis showed that Grade Group of 5 and prostate-specific antigen doubling time at biochemical recurrence of ≤3 months were independent predictors of castration-resistant prostate cancer. The 5-year castration-resistant prostate cancer-free survival rates in the low- and high-risk groups, stratified according to the aforementioned factors, were 85.4% and 47.6%, respectively.
Patients in high Grade Group and short prostate-specific antigen doubling time after radical prostatectomy are more likely to develop resistance to salvage hormonal therapy.
背景/目的：在接受根治性前列腺切除术后发生生化复发的患者中，研究从开始激素治疗到去势抵抗性前列腺癌发生的具体时间框架，并确定相关危险因素。
我们回顾性分析了2005年至2021年间92例高危局限性前列腺癌患者的记录，这些患者在根治性前列腺切除术后发生生化复发，并接受激素治疗作为初始挽救治疗。采用对数秩检验方法分析从挽救性激素治疗开始的去势抵抗性前列腺癌无进展生存率。进行Cox比例风险回归分析以确定与获得去势抵抗相关的危险因素。根据这些危险因素对患者进行分层。
在中位随访时间57个月期间，24例（26.1%）患者发生了去势抵抗性前列腺癌。5年和10年去势抵抗性前列腺癌无进展生存率分别为73.6%和54.5%。多因素分析显示，5级组和生化复发时前列腺特异性抗原倍增时间≤3个月是去势抵抗性前列腺癌的独立预测因素。根据上述因素分层的低风险和高风险组的5年去势抵抗性前列腺癌无进展生存率分别为85.4%和47.6%。
根治性前列腺切除术后处于高级别组且前列腺特异性抗原倍增时间短的患者更有可能对挽救性激素治疗产生抵抗。
