Cadeddu J A, Partin A W, DeWeese T L, Walsh P C
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 1998 Jan;159(1):173-7; discussion 177-8. doi: 10.1016/s0022-5347(01)64047-3.
Following radical prostatectomy, radiation therapy may be beneficial in select patients with isolated local recurrence. Pathological stage, Gleason score and the timing of prostate specific antigen (PSA) elevation are useful in distinguishing men with local recurrence from those with distant metastases. We test the ability of these criteria to predict long-term suppression of PSA recurrence following post-prostatectomy radiation therapy.
Of 1,699 men treated with radical prostatectomy from 1982 to 1995, 82 with an isolated PSA elevation or local recurrence following surgery underwent radiation therapy to the prostatic bed and were followed for at least 2 years. No patient had evidence of metastases at the time of radiation.
Of the men 17 (21%) had an undetectable PSA (less than 0.2 ng./ml.) for 2 or greater years following radiation. The 5-year actuarial PSA recurrence-free rate after radiation was 10%. PSA remained at undetectable levels for 2 or greater years in no patients with Gleason score 8 or greater (12 cases), positive seminal vesicles (12) or positive lymph nodes (3), and in only 1 of 16 men (6%) who had a PSA recurrence within 1 year of prostatectomy. As the interval to PSA recurrence increased, the likelihood of responding to radiotherapy increased to 44% if initial disease detection occurred 5 or more years after prostatectomy. There was no demonstrated advantage to radiating men with an isolated PSA elevation before a documented local recurrence.
Patients with Gleason score 8 or greater, positive seminal vesicles or lymph nodes, or a PSA recurrence within the first year following surgery rarely benefit from radiation therapy. As the interval to PSA recurrence increases, the likelihood of responding to radiation therapy increases substantially. These parameters are useful in the selection of patients with prostate cancer recurrences who are likely to benefit from radiation to the prostatic bed.
根治性前列腺切除术后，放射治疗可能对某些孤立性局部复发的患者有益。病理分期、Gleason评分以及前列腺特异性抗原（PSA）升高的时间，对于区分局部复发的男性与远处转移的男性很有用。我们测试这些标准预测前列腺切除术后放射治疗后PSA复发长期抑制的能力。
1982年至1995年接受根治性前列腺切除术的1699名男性中，82名术后出现孤立性PSA升高或局部复发的患者接受了前列腺床放射治疗，并随访至少2年。放疗时无患者有转移证据。
放疗后，17名男性（21%）的PSA在2年或更长时间内检测不到（低于0.2 ng/ml）。放疗后5年的PSA无复发生存率为10%。Gleason评分为8分或更高（12例）、精囊阳性（12例）或淋巴结阳性（3例）的患者中，没有患者的PSA在2年或更长时间内保持检测不到的水平，在前列腺切除术后1年内出现PSA复发的16名男性中，只有1名（6%）的PSA保持在检测不到的水平。随着PSA复发间隔时间的增加，如果在前列腺切除术后5年或更长时间发现初始疾病，对放疗有反应的可能性增加到44%。在记录的局部复发之前，对孤立性PSA升高的男性进行放疗没有显示出优势。
Gleason评分为8分或更高、精囊或淋巴结阳性，或术后第一年内出现PSA复发的患者很少从放射治疗中获益。随着PSA复发间隔时间的增加，对放射治疗有反应的可能性大幅增加。这些参数有助于选择可能从前列腺床放射治疗中获益的前列腺癌复发患者。
