Ward Jennifer, Armstrong Kevin, Kang Therese Min-Jung, Tham Jodie, Lin Yuan-Hong, Cheng Marcus, Grummet Jeremy, Lawrentschuk Nathan, Perera Marlon, Sengupta Shomik, Chang David, Ng Michael, Bensley Jonathan, Steeper Michelle, Krishnaprasad Krupa, Johnson Maggie, Zeps Nikolajs, Millar Jeremy, Ong Wee Loon
Alfred Health Radiation Oncology, School of Translational Medicine Monash University Melbourne VIC Australia.
Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Research Centre Austin Health Heidelberg VIC Australia.
BJUI Compass. 2025 Jul 21;6(7):e70059. doi: 10.1002/bco2.70059. eCollection 2025 Jul.
To evaluate the patterns of management of clinical node-positive non-metastatic prostate cancer (cN1M0PC) at a population-based level over time, and to identify factors associated with the different management approaches.
The study included men diagnosed with cN1M0PC in Prostate Cancer Outcome Registry Victoria (PCOR-Vic) in Australia between 2008 and 2022. The primary outcome was the use of local therapy (radical prostatectomy or prostate+/- pelvic radiation therapy) within the first 12 months of diagnosis. Multivariable logistic regressions were used to evaluate factors associated with local therapy use among all men and the likelihood of having a radical prostatectomy among men who had local therapy.
Of the 819 men included in this study, 52% had PSMA-PET staging, and this increased over time to 74% in 2018-2022. There were 530 (65%) who had local therapy (169 radical prostatectomy, and 361 radiation therapy), 259 (32%) had systemic therapy alone, and 30 (4%) did not have any treatment. There was an increase in the proportion of men who had local therapy over time, from 52% in 2008-2012 to 72% in 2018-2022. In multivariable analyses, increased age, higher PSA and residency in regional/remote areas were independently associated with lower likelihood of local therapy use, while PSMA-PET staging and more recent year of diagnosis were associated with higher likelihood of local therapy use. Of the 530 men who had local therapy, increased age, higher PSA, higher ISUP grade group and higher clinical T categories were associated with a lower likelihood of having radical prostatectomy while men diagnosed in private institutions and from higher socioeconomic quintiles were more likely to have radical prostatectomy.
This is the largest contemporaneous population-based study on the management of cN1M0PC in the PSMA-PET era. There is an increasing use of local therapy for cN1M0PC over time, with large variations in practice.
评估基于人群的临床淋巴结阳性非转移性前列腺癌（cN1M0PC）随时间推移的管理模式，并确定与不同管理方法相关的因素。
该研究纳入了2008年至2022年期间在澳大利亚维多利亚州前列腺癌结局登记处（PCOR-Vic）被诊断为cN1M0PC的男性。主要结局是在诊断后的前12个月内使用局部治疗（根治性前列腺切除术或前列腺±盆腔放射治疗）。多变量逻辑回归用于评估所有男性中与使用局部治疗相关的因素，以及接受局部治疗的男性进行根治性前列腺切除术的可能性。
在本研究纳入的819名男性中，52% 进行了PSMA-PET分期，这一比例随时间增加，在2018 - 2022年达到74%。有530人（65%）接受了局部治疗（169例行根治性前列腺切除术，361例行放射治疗），259人（32%）仅接受了全身治疗，30人（4%）未接受任何治疗。随着时间的推移，接受局部治疗的男性比例有所增加，从2008 - 2012年的52%增至2018 - 2022年的72%。在多变量分析中，年龄增加、PSA水平较高以及居住在地区/偏远地区与使用局部治疗的可能性较低独立相关，而PSMA-PET分期和较近的诊断年份与使用局部治疗的可能性较高相关。在530名接受局部治疗的男性中，年龄增加、PSA水平较高、ISUP分级组较高以及临床T类别较高与进行根治性前列腺切除术的可能性较低相关，而在私立机构诊断的男性以及社会经济五分位数较高的男性更有可能进行根治性前列腺切除术。
这是PSMA-PET时代关于cN1M0PC管理的最大规模的同期基于人群的研究。随着时间的推移，cN1M0PC的局部治疗使用越来越多，但实践中存在很大差异。
