Sakai Yasuyuki, Shindo Tetsuya, Hashimoto Kohei, Ito Naoki, Kobayashi Genki, Kato Ryuichi, Miyamoto Shintaro, Okada Manabu, Matsukawa Masanori, Sato Shunsuke, Takayanagi Akio, Kato Shuichi, Kunishima Yasuharu, Wanifuchi Atsushi, Horita Hiroki, Maehana Takeshi, Kyoda Yuki, Kobayashi Ko, Tanaka Toshiaki, Masumori Naoya
Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Urology, Oji General Hospital, Tomakomai, Japan.
Curr Urol. 2025 Sep;19(5):314-320. doi: 10.1097/CU9.0000000000000293. Epub 2025 Jul 16.
To assess the efficacy of metastasis-directed external beam radiotherapy (MDT) in patients with castration-resistant prostate cancer (CRPC), we conducted a multicenter retrospective study.
We retrospectively analyzed data from patients with metastatic CRPC treated with MDT between January 2013 and July 2023 across 14 hospitals. Patients who received palliative or local radiation therapy or had insufficient clinical data were excluded. The primary endpoint was the change in prostate-specific antigen (PSA) levels from pre- to post-MDT. Secondary endpoints included overall survival, time to next systemic therapy, PSA progression-free survival, and reduction of target lesions assessed radiographically.
Among 579 patients with metastatic prostate cancer who received radiation therapy, 48 underwent MDT. The median follow-up period was 325 days, and the median patient age was 74 years. Metastasis-directed external beam radiotherapy target sites included bone (n = 34, 70.8%), lymph nodes (n = 11, 22.9%), local recurrence (n = 2, 4.2%), and other sites (n = 1, 2.1%). Of the 48 patients, 30 (62.5%) showed a decrease in PSA levels after MDT, and 20 (41.6%) achieved a PSA reduction greater than 50%. Among the 26 patients who underwent post-MDT radiographic evaluation, 11 (42.3%) demonstrated a reduction in target lesions. Median overall survival, PSA progression-free survival, and time to next systemic therapy for patients with and without a PSA response were 1307 versus 614 days ( = 0.038, log-rank test), 233 versus 98 days ( = 0.014, log-rank test), and 434 versus 450 days ( = 0.273, log-rank test), respectively. The median PSA doubling time was 4.1 months in PSA responders and 1.7 months in nonresponders.
Metastasis-directed external beam radiotherapy resulted in PSA reduction in 62.5% of patients with metastatic CRPC. Metastasis-directed external beam radiotherapy may be a suitable treatment option for patients with a favorable prognosis but may not benefit those with a poor prognosis and short PSA doubling time.
为评估转移性去势抵抗性前列腺癌（CRPC）患者中转移灶定向外照射放疗（MDT）的疗效，我们开展了一项多中心回顾性研究。
我们回顾性分析了2013年1月至2023年7月期间在14家医院接受MDT治疗的转移性CRPC患者的数据。排除接受姑息性或局部放疗或临床数据不足的患者。主要终点是MDT前后前列腺特异性抗原（PSA）水平的变化。次要终点包括总生存期、至下一次全身治疗的时间、PSA无进展生存期以及影像学评估的靶病灶缩小情况。
在579例接受放疗的转移性前列腺癌患者中，48例接受了MDT。中位随访期为325天，患者中位年龄为74岁。转移灶定向外照射放疗的靶部位包括骨骼（n = 34，70.8%）、淋巴结（n = 11，22.9%）、局部复发（n = 2，4.2%）和其他部位（n = 1，2.1%）。48例患者中，30例（62.5%）在MDT后PSA水平下降，20例（41.6%）PSA降低超过50%。在26例接受MDT后影像学评估的患者中，11例（42.3%）靶病灶缩小。有PSA反应和无PSA反应患者的中位总生存期、PSA无进展生存期和至下一次全身治疗的时间分别为1307天对614天（P = 0.038，对数秩检验）、233天对98天（P = 0.014，对数秩检验）和434天对450天（P = 0.273，对数秩检验）。PSA反应者的中位PSA倍增时间为4.1个月，无反应者为1.7个月。
转移灶定向外照射放疗使62.5%的转移性CRPC患者PSA降低。转移灶定向外照射放疗可能是预后良好患者的合适治疗选择，但对预后不良且PSA倍增时间短的患者可能无益处。
