Kawahara Masahiro, Tanaka Akira, Akahane Keiko, Endo Masashi, Fukuda Yukiko, Okada Kohei, Ogawa Kazunari, Takahashi Satoru, Nakamura Michiko, Konishi Tsuzumi, Saito Kimitoshi, Washino Satoshi, Miyagawa Tomoaki, Hiruta Masahiro, Oshiro Hisashi, Oyama-Manabe Noriko, Shirai Katsuyuki
Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Cancer Diagn Progn. 2024 Nov 3;4(6):715-721. doi: 10.21873/cdp.10386. eCollection 2024 Nov-Dec.
BACKGROUND/AIM: In prostate cancer, robotic total prostatectomy is a popular treatment modality. However, prostate-specific antigen (PSA) recurrence after prostate cancer surgery remains a concern. Salvage radiotherapy is commonly used to treat PSA recurrence, but the recurrence rate after salvage radiotherapy is high, highlighting the need for better predictive markers. This study aimed to retrospectively evaluate the association between cribriform pattern and PSA recurrence in patients receiving radiotherapy after radical prostatectomy.
Data of 50 patients who underwent radiotherapy after total prostatectomy between January 2010 and May 2020 were retrospectively evaluated. The median age was 67 years. Among these patients, two cases involved postoperative irradiation, while 48 cases involved salvage irradiation after postoperative PSA recurrence. The median time from surgery to PSA recurrence was 38.3 months. The median radiation dose was 64 Gy in 32 fractions. Three-dimensional conformal radiation therapy was administered in 38 cases and intensity-modulated radiation therapy was used in 12 cases. Combined hormone therapy was administered in 21 cases. PSA levels were measured every 3 months after treatment. Statistical analysis between groups was performed by a t-test.
The median follow-up period after radiotherapy was 31 months. No local recurrences were observed at the prostate bed, and no deaths related to prostate cancer were recorded during follow-up. However, 18 patients (36.0%) had PSA recurrence. The PSA recurrence rate based on the cribriform pattern was 17.6% in the none to moderate group (34 patients) and 75.0% in the severe cribriform pattern group (16 patients). The PSA recurrence rate was significantly higher in patients with a severe invasive cribriform pattern (p=0.001). No significant differences were observed in other histopathological characteristics.
The cribriform pattern in surgical pathology specimens was found to be a useful predictor of PSA recurrence after postoperative radiotherapy.
背景/目的：在前列腺癌中，机器人辅助全前列腺切除术是一种常用的治疗方式。然而，前列腺癌手术后前列腺特异性抗原（PSA）复发仍是一个令人担忧的问题。挽救性放疗常用于治疗PSA复发，但挽救性放疗后的复发率较高，这凸显了对更好的预测标志物的需求。本研究旨在回顾性评估根治性前列腺切除术后接受放疗的患者中筛状模式与PSA复发之间的关联。
回顾性评估2010年1月至2020年5月间50例行全前列腺切除术后接受放疗的患者的数据。中位年龄为67岁。在这些患者中，2例为术后放疗，48例为术后PSA复发后的挽救性放疗。从手术到PSA复发的中位时间为38.3个月。中位放疗剂量为64 Gy，分32次给予。38例采用三维适形放疗，12例采用调强放疗。21例采用联合激素治疗。治疗后每3个月测量PSA水平。组间统计分析采用t检验。
放疗后的中位随访期为31个月。在前列腺床未观察到局部复发，随访期间未记录到与前列腺癌相关的死亡。然而，18例患者（36.0%）出现PSA复发。筛状模式为无至中度的组（34例患者）的PSA复发率为17.6%，重度筛状模式组（16例患者）的PSA复发率为75.0%。重度浸润性筛状模式患者的PSA复发率显著更高（p = 0.001）。在其他组织病理学特征方面未观察到显著差异。
手术病理标本中的筛状模式被发现是术后放疗后PSA复发的一个有用预测指标。
