King Martin, Mirić Grgur, Galbreath Robert, Fiano Ryan, Moningi Shalini, Wallner Kent, Orio Peter
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
Urologic Research Institute, Sarasota, FL, USA.
Prostate Cancer Prostatic Dis. 2025 Sep 11. doi: 10.1038/s41391-025-01021-3.
Current National Comprehensive Cancer Network guidelines define brachytherapy monotherapy as a suitable treatment for favorable intermediate risk (FIR) and unfavorable intermediate risk (UIR) prostate cancer. Our objective is to define the subgroup of patients suitable for brachytherapy monotherapy.
We conducted a single-institutional retrospective analysis of intermediate risk prostate cancer, treated with brachytherapy with or without androgen deprivation therapy (ADT) and/or external beam radiation therapy (EBRT). The primary endpoint was biochemical failure (BF), defined as prostate specific antigen (PSA) > 0.4 ng/mL. For monotherapy, multivariate Fine-Gray analysis was used to identify risk factors associated with BF. Univariate analysis was performed to evaluate whether ADT and/or EBRT were associated with BF for patients without and with such factors.
Among 1622 patients, the median follow-up was 10.4 years. For monotherapy, PSA ≥ 10 ng/mL (adjusted sHR 3.01; 95% CI: 1.10-8.27; p = 0.032) and cT2b-c disease (adjusted sHR 4.52; 95% CI: 1.85-11.07; p = 0.001) were associated with BF. The 10-year incidences of BF after monotherapy for patients without and with these risk factors were 5.8% (3.8% FIR, 8.8% UIR) versus 17.2% (9.3% FIR, 23.9% UIR), respectively. For the cT1-T2a/PSA < 10 risk group, neither the addition of ADT (sHR 0.90; 95% CI: 0.38-2.1; p = 0.82) nor EBRT (sHR 0.65; 95% CI: 0.36-1.18; p = 0.16) was associated with biochemical failure. For the cT2b-T2c and/or PSA ≥ 10 subgroup, ADT (sHR: 0.33; 95% CI: 0.14-0.74; p = 0.007) but not EBRT (sHR 0.66; 95% CI: 0.34-1.31; p = 0.24) was associated with BF.
Brachytherapy monotherapy is suitable for all FIR, and UIR disease meeting cT1-T2a/PSA < 10 criteria.
当前美国国立综合癌症网络指南将近距离放射治疗单一疗法定义为低危中危（FIR）和高危中危（UIR）前列腺癌的一种合适治疗方法。我们的目的是确定适合近距离放射治疗单一疗法的患者亚组。
我们对接受近距离放射治疗联合或不联合雄激素剥夺治疗（ADT）和/或外照射放疗（EBRT）的中危前列腺癌患者进行了单机构回顾性分析。主要终点是生化复发（BF），定义为前列腺特异性抗原（PSA）>0.4 ng/mL。对于单一疗法，采用多变量Fine-Gray分析来确定与BF相关的危险因素。进行单变量分析以评估ADT和/或EBRT对于有无这些因素的患者是否与BF相关。
在1622例患者中，中位随访时间为10.4年。对于单一疗法，PSA≥10 ng/mL（校正后sHR 3.01；95%CI：1.10 - 8.27；p = 0.032）和cT2b - c期疾病（校正后sHR 4.52；95%CI：1.85 - 11.07；p = 0.001）与BF相关。无这些危险因素和有这些危险因素的患者单一疗法后10年BF发生率分别为5.8%（FIR为3.8%，UIR为8.8%）和17.2%（FIR为9.3%，UIR为23.9%）。对于cT1 - T2a/PSA < 10风险组，添加ADT（sHR 0.90；95%CI：0.38 - 2.1；p = 0.82）和EBRT（sHR 0.65；95%CI：0.36 - 1.18；p = 0.16）均与生化复发无关。对于cT2b - T2c和/或PSA≥10亚组，ADT（sHR：0.33；95%CI：0.14 - 0.74；p = 0.007）而非EBRT（sHR 0.66；95%CI：0.34 - 1.31；p = 0.24）与BF相关。
近距离放射治疗单一疗法适用于所有符合cT1 - T2a/PSA < 10标准的FIR和UIR疾病。
