前列腺特异性抗原（PSA）降低作为接受根治性放疗的低危和预后良好的中危前列腺癌生化复发的预测指标

PSA reduction as predictor of biochemical relapse in low and favourable intermediate prostate cancer treated with radical radiotherapy.

作者信息

Allegra Andrea Gaetano, Nicosia Luca, Molinari Alessandro, De-Colle Chiara, Fierro Christian, Giaj-Levra Niccolò, Giannetti Francesca, Menichelli Claudia, Orsatti Carolina, Pastore Gabriella, Pastorello Edoardo, Ricchetti Francesco, Rigo Michele, Romei Andrea, Zuccoli Paola, Fanelli Alessandro, Alongi Filippo

机构信息

Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37024, Negrar Di Valpolicella, VR, Italy.

Radiotherapy Department, Ecomedica Poliambulatorio Ergéa Group, Via Cherubini 2, 50053, Empoli, FI, Italy.

出版信息

Clin Transl Oncol. 2025 Apr 12. doi: 10.1007/s12094-025-03884-3.

DOI:10.1007/s12094-025-03884-3

PMID:40220123

Abstract

PURPOSE

Radiation therapy (RT) is standard treatment for localized prostate cancer (PCa). Prostate-specific antigen (PSA) kinetics, particularly PSA reduction (PSAr) after RT, are emerging as significant prognostic indicators for biochemical control. This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS). This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS).

METHODS

251 low-to-intermediate risk PCa patients treated with RT only were analyzed. Isoeffective RT schedules were: 39 fractions × 2 Gy, 28 × 2.55 Gy, 16 × 3.5 Gy, 5 × 7 Gy. Main objective was BRFS, defined as the time from PSA nadir (PSAn) to PSAn plus 2 ng/ml. PSAr was defined as the percentage of total PSA reduction from baseline. The optimal PSAr cut-off value was defined as 90%. Patients were stratified by PSAr, baseline PSA, Gleason Score (GS), and RT schedules.

RESULTS

GS was 3 + 3 in 120 (48%) patients and 3 + 4 in 131 (52%) patients. After a median follow-up of 36 months (30-48), 2 and 5-year BRFS were 97.3% and 95.2%, respectively, in patients with PSAr ≥ 90% and 89.5%, 61.5% in patients with PSAr < 90% (p = 0.00). In the responder population, median time to PSAr 90% was 24 months and the median time to PSAn was 28.7 months (20-38). At univariate and multivariate analyses, PSAr was the only significant predictor of BRFS [HR 6.519 (95% IC 1.9-22.2), p = 0.003].

CONCLUSIONS

PSAr could be a reliable prognostic factor for long-term biochemical control. This study underscores the potential of PSAr as a tool for risk stratification and personalized follow-up strategies in PCa management.

摘要

目的

放射治疗（RT）是局限性前列腺癌（PCa）的标准治疗方法。前列腺特异性抗原（PSA）动力学，尤其是放疗后的PSA降低（PSAr），正逐渐成为生化控制的重要预后指标。这项回顾性多机构研究探讨了PSAr与无生化复发生存期（BRFS）之间的相关性。这项回顾性多机构研究探讨了PSAr与无生化复发生存期（BRFS）之间的相关性。

方法

分析了251例仅接受放疗的低至中度风险PCa患者。等效放疗方案为：39次分割×2Gy、28次分割×2.55Gy、16次分割×3.5Gy、5次分割×7Gy。主要观察指标是BRFS，定义为从PSA最低点（PSAn）到PSAn加2ng/ml的时间。PSAr定义为总PSA从基线降低的百分比。最佳PSAr临界值定义为90%。患者按PSAr、基线PSA、 Gleason评分（GS）和放疗方案进行分层。

结果

120例（48%）患者的GS为3+3，131例（52%）患者的GS为3+4。中位随访时间为36个月（30-48个月），PSAr≥90%的患者2年和5年BRFS分别为97.3%和95.2%，PSAr<90%的患者为89.5%、61.5%（p=0.00）。在有反应的人群中，达到PSAr 90%的中位时间为24个月，达到PSAn的中位时间为28.7个月（20-38个月）。在单因素和多因素分析中，PSAr是BRFS的唯一显著预测因素[风险比6.519（95%置信区间1.9-22.2），p=0.003]。