Dejonckheere Cas Stefaan, Caglayan Lara, Glasmacher Andrea Renate, Wiegreffe Shari, Layer Julian Philipp, Nour Younèss, Scafa Davide, Sarria Gustavo Renato, Spohn Simon, Essler Markus, Hauser Stefan, Ritter Manuel, Bernhardt Marit, Kristiansen Glen, Grosu Anca-Ligia, Zamboglou Constantinos, Gkika Eleni
Department of Radiation Oncology, University Hospital Bonn, Germany.
Department of Radiation Oncology, University Hospital Bonn, Germany.
Radiother Oncol. 2025 Jan;202:110642. doi: 10.1016/j.radonc.2024.110642. Epub 2024 Nov 16.
Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.
A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.
Thirty-three records (45 % prospective) encompassing 9949 patients were included. SBRT dose ranged from 32-50 Gy in 4-5 fractions and overall median follow-up time (range) was 41 (15-74) months. Use of androgen deprivation therapy ranged from 0-38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1-0.6) ng/mL after a median time (range) of 33.1 (6-54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (r = - 0.59; p < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9-36) months and with a median size (range) of 0.5 (0.3-1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (r = -0.49; p = 0.046).
PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.
立体定向体部放疗（SBRT）正成为局部前列腺癌一种有价值的治疗方式，生化无进展生存率前景良好。前列腺特异性抗原（PSA）的纵向评估是治疗后随访的主要手段。在近距离放疗和传统分割放疗背景下，PSA的动力学和动态变化已得到充分认识，但在前列腺SBRT背景下却知之甚少。
对MEDLINE、Scopus和Embase中的可用文献进行综述，重点关注报告前列腺SBRT后PSA斜率、最低点、反弹及生化失败情况的研究。
纳入了33篇记录（45%为前瞻性研究），涉及9949例患者。SBRT剂量为32 - 50 Gy，分4 - 5次给予，总体中位随访时间（范围）为41（15 - 74）个月。雄激素剥夺治疗的使用比例为0 - 38%。SBRT的特点是PSA最初急剧下降，随后随时间减缓，最终与传统放疗相比最低点更低，在中位时间（范围）33.1（6 - 54）个月后，中位值（范围）为0.24（0.1 - 0.6）ng/mL。试验中的最高SBRT剂量与PSA最低点呈负相关（r = - 0.59；p < 0.001）。在所有研究中，30%的患者出现良性PSA反弹，中位时间（范围）为14.8（9 - 36）个月，中位幅度（范围）为0.5（0.3 - 1.1）ng/mL。反弹与剂量、最低点及生化失败之间无显著相关性。然而，雄激素剥夺治疗的使用与PSA反弹频率之间存在显著负相关（r = - 0.49；p = 0.046）。
局部前列腺癌SBRT后的PSA动力学和动态变化与其他既定放疗方式不同。良性PSA反弹非常常见。临床医生应了解这些因素，并相应地对患者进行咨询，以避免不必要的困扰或挽救性治疗。
