Nishiyama Hiroki, Kawaguchi Gen, Ito Kozue, Hasegawa Go, Ikeda Yohei, Hara Noboru, Nishiyama Tsutomu
Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan.
Department of Radiation Oncology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan.
Res Rep Urol. 2025 Sep 11;17:327-339. doi: 10.2147/RRU.S544477. eCollection 2025.
To investigate outcomes of patients with biochemical or local recurrence, without distant metastasis, who received radiation therapy targeting the prostate bed at our hospital following radical prostatectomy for prostate cancer.
Patients suspected of recurrence after radical prostatectomy, indicated by an increase in PSA levels or other factors, were evaluated through imaging tests for local recurrence and distant metastasis. Those who showed no local recurrence received salvage radiotherapy to the prostate bed at a dose of 64.8 Gy. Patients with local recurrence received radiotherapy of 70.8 Gy to the site of local recurrence and 64.8 Gy to the prostate bed.
Among 19 cases of local recurrence following radical prostatectomy, three out of nine patients who did not receive ADT experienced recurrence after local radiation therapy. In contrast, none of the ten patients who received ADT during radiation therapy experienced recurrence following treatment. No significant difference was observed in clinical recurrence-free survival between patients receiving radiation therapy alone and those receiving ADT during radiation therapy. (p = 0.302) Fifty-six of the 57 patients without local recurrence were evaluated regarding their PSA doubling time (PSADT). Those with a PSADT of 6 months or more at the time of recurrence following radical prostatectomy tended to show longer clinical recurrence-free survival after local radiation therapy compared with showing PSADT of less than 6 months. (p=0.06) Patients with local recurrence who were treated with escalated radiation doses did not show any difference in the incidence of radiotherapy-related gastrointestinal toxicity compared with patients without local recurrence.
Although this study was conducted at a single institution with a small sample size and a limited number of patients, ADT may be beneficial in preventing recurrence following radiation therapy for local recurrence after radical prostatectomy. When considering salvage radiation therapy for patients with biochemical recurrence following radical prostatectomy, PSADT may be useful.
调查在我院接受前列腺癌根治性切除术后针对前列腺床进行放射治疗的生化复发或局部复发且无远处转移患者的治疗结果。
对于因前列腺特异性抗原（PSA）水平升高或其他因素怀疑根治性前列腺切除术后复发的患者，通过影像学检查评估局部复发和远处转移情况。未显示局部复发的患者接受前列腺床挽救性放疗，剂量为64.8 Gy。局部复发的患者接受局部复发部位70.8 Gy和前列腺床64.8 Gy的放疗。
在19例根治性前列腺切除术后局部复发的病例中，9例未接受雄激素剥夺治疗（ADT）的患者中有3例在局部放疗后复发。相比之下，放疗期间接受ADT的10例患者中无一例在治疗后复发。单纯接受放疗的患者与放疗期间接受ADT的患者在临床无复发生存方面未观察到显著差异（p = 0.302）。57例无局部复发的患者中有56例评估了其PSA倍增时间（PSADT）。与PSADT小于6个月的患者相比，根治性前列腺切除术后复发时PSADT为6个月或更长时间的患者在局部放疗后往往显示出更长的临床无复发生存期（p = 0.06）。接受更高剂量放疗的局部复发患者与无局部复发患者相比，放疗相关胃肠道毒性发生率无差异。
尽管本研究是在单一机构进行，样本量小且患者数量有限，但ADT可能有助于预防根治性前列腺切除术后局部复发放疗后的复发。在考虑对根治性前列腺切除术后生化复发患者进行挽救性放疗时，PSADT可能有用。
