Freedman G M, Hanlon A L, Lee W R, Hanks G E
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Int J Radiat Oncol Biol Phys. 1996 May 1;35(2):243-50. doi: 10.1016/0360-3016(96)00017-x.
The majority of young patients with early stage prostate cancer in the United States are treated with radical prostatectomy. To determine whether this preference for surgical care is justified, we analyzed by patient age the survival without biochemical evidence of disease (bNED) of men with clinically organ-confined prostate cancer treated with external beam irradiation.
One hundred and sixty-nine men with clinical stages T1-2 adenocarcinoma of the prostate received external beam radiation therapy alone at Fox Chase Cancer Center. All patients had serum prostate-specific antigen (PSA) values less than 10 ng/ml prior to initiation of treatment. Out of 169 patients, 167 had unstaged regional nodes (NX) and all had no evidence for distant metastasis (M0). The median age was 69 years. Criteria for bNED survival were posttreatment serum PSA < or = 1.5 ng/ml and not rising on two consecutive values. The median follow-up is 35 months.
The actuarial 5-year bNED survival of all 169 patients was 85%. The bNED survival of patients less than 65 was not significantly different than that of patients 65 and older (89 vs. 84%, respectively). Patient age, American Joint Committee on Cancer (AJCC) stage, palpation stage, Gleason score, and dose to the center of the prostate were not found to be significant predictors of bNED survival on multivariate analysis.
Our results using strict biochemical endpoints are comparable to reported series of similarly staged men treated with prostatectomy. In addition, the patient age of less than 65 is not a prognostic factor for worse outcome after radiation therapy. Young patients with clinically organ-confined prostate cancer who are fully informed of their treatment options can be appropriately accepted for external beam treatment.
在美国，大多数早期前列腺癌的年轻患者接受根治性前列腺切除术治疗。为了确定这种对手术治疗的偏好是否合理，我们按患者年龄分析了接受外照射治疗的临床器官局限性前列腺癌男性患者无疾病生化证据（bNED）的生存率。
169例临床分期为T1-2期前列腺腺癌的男性患者在福克斯蔡斯癌症中心仅接受了外照射放疗。所有患者在开始治疗前血清前列腺特异性抗原（PSA）值均小于10 ng/ml。169例患者中，167例区域淋巴结未分期（NX），且均无远处转移证据（M0）。中位年龄为69岁。bNED生存的标准为治疗后血清PSA≤1.5 ng/ml且连续两次检查值未升高。中位随访时间为35个月。
所有169例患者的精算5年bNED生存率为85%。年龄小于65岁患者的bNED生存率与65岁及以上患者的生存率无显著差异（分别为89%和84%）。多因素分析未发现患者年龄、美国癌症联合委员会（AJCC）分期、触诊分期、Gleason评分以及前列腺中心剂量是bNED生存的显著预测因素。
我们使用严格生化终点得出的结果与报道的接受前列腺切除术治疗的分期相似男性患者系列结果相当。此外，年龄小于65岁并非放疗后预后较差的预测因素。充分了解治疗选择的临床器官局限性前列腺癌年轻患者可以接受外照射治疗。
