Heutlinger Olivia, Azizi Armon, Harada Garrett, Harris Jeremy P, Daneshvar Michael, Gin Greg, Uchio Edward, Mar Nataliya, Rezazadeh Arash, Seyedin Steven N
Radiation Oncology, University of California Irvine School of Medicine, Irvine, USA.
Radiation Oncology, University of California Irvine Medical Center, Orange, USA.
Cureus. 2024 Sep 8;16(9):e68945. doi: 10.7759/cureus.68945. eCollection 2024 Sep.
Purpose This study aimed to identify factors associated with delays in initiating early salvage radiation therapy in prostate cancer patients with prostate-specific antigen (PSA) failure after prostatectomy. Methods We conducted a single-institution, retrospective study of patients receiving salvage radiation therapy after radical prostatectomy from 2011 to 2022. Patient demographics and clinical data were examined to identify factors that may have influenced the time to start of radiation therapy after surgery. Utilizing a PSA cut off of 0.25 ng/ml or less, we classified patients as receiving either early "PSA low" or late "PSA high" salvage therapy depending on their PSA at the time of initiating treatment. Results Of the 81 patients evaluated, the median age was 61.9 years (IQR 57.9 - 66.5), with most presenting with pT3 (65.4%), Grade Group 2 disease (35.8%), and positive margins 55%). Median PSA at salvage radiation therapy commencement was 0.30 ng/mL (0.18 - 0.48). 40 patients completed early salvage and 41 patients completed late salvage in the overall cohort. A significant association was found between patient insurance carrier and pre-radiation PSA levels. Patients with HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) insurance were more likely to complete late salvage radiation compared to non-managed Medicare patients (HMO OR 4.0, p <0.05 & PPO OR 3.3 p <0.05 vs non-managed Medicare). All uninsured patients in the cohort received late salvage radiation. Conclusions Insurance type was significantly associated with the timing of salvage radiation therapy post-prostatectomy, suggesting a relationship with providers requiring prior authorization (HMO and PPO coverage). This study supports proper PSA surveillance, in particular for those with HMO or PPO coverage.
目的 本研究旨在确定前列腺切除术后前列腺特异性抗原（PSA）失败的前列腺癌患者早期挽救性放射治疗开始延迟的相关因素。方法 我们对2011年至2022年接受根治性前列腺切除术后挽救性放射治疗的患者进行了单机构回顾性研究。检查患者人口统计学和临床数据，以确定可能影响术后放射治疗开始时间的因素。利用0.25 ng/ml或更低的PSA临界值，根据患者开始治疗时的PSA将其分类为接受早期“PSA低”或晚期“PSA高”挽救性治疗。结果 在评估的81例患者中，中位年龄为61.9岁（四分位间距57.9 - 66.5），大多数表现为pT3（65.4%）、2级疾病（35.8%）和切缘阳性（55%）。挽救性放射治疗开始时的中位PSA为0.30 ng/mL（0.18 - 0.48）。在整个队列中，40例患者完成了早期挽救，41例患者完成了晚期挽救。发现患者保险承保人与放疗前PSA水平之间存在显著关联。与非管理型医疗保险患者相比，拥有健康维护组织（HMO）或优先提供者组织（PPO）保险的患者更有可能完成晚期挽救性放射治疗（HMO优势比4.0，p <0.05；PPO优势比3.3，p <0.05，与非管理型医疗保险相比）。队列中的所有未参保患者均接受了晚期挽救性放射治疗。结论 保险类型与前列腺切除术后挽救性放射治疗的时间显著相关，表明与需要事先批准的提供者（HMO和PPO保险）有关。本研究支持适当的PSA监测，特别是对于那些拥有HMO或PPO保险的患者。
