Objective: To investigate the oncologic outcome and PSA kinetics of localized high-risk prostate cancer (PCa) patients treated with combination strategy of radiation therapy (RT) and maximal androgen blockade (MAB). Methods: We retrospectively reviewed the clinical data of 320 localized PCa patients undergoing RT+ MAB from 2001 to 2015. And radiation treatment protocol consisted of permanent prostate brachytherapy (PPB) at 110 Gy and EBRT at 45 Gy/23 fractions. Results: The median follow-up time was 90 (range: 12-186) months. And 117 (36.6%) cases underwent MAB + external-beam radiotherapy (EBRT), and other 203 (63.4%) cases received MAB+ EBRT+ PPB. Multivariate Cox regression analyses showed that PSA kinetics were positive indicators of oncologic outcomes. Furthermore, PSA kinetics were aberrantly improved by supplemental PPB to MAB+ EBRT as following, PSA nadir (1.3±0.7)μg/L vs(0.11±0.06)μg/L, time of PSA decrease to nadir (7.5±1.8)months vs (3.2±2.1)months, PSA doubling time (15.6±4.2)months vs (22.6±6.1)months, PSA decreasing amplitude (84.6±6.2)%vs(95.8±3.4)%. Additionally, the median time of several important oncologic events in MAB+ EBRT+ PPB group were also prolonged than that in MAB+ EBRT group as following, overall survival (12.3 years vs 9.1 years, P<0.001), biochemical recurrence-free survival (9.8 years vs 6.5 years, P<0.001), skeletal-related event (10.4years vs 8.2 years, P<0.001), and cytotoxic chemotherapy (11.6 years vs 8.8 years, P=0.007). Conclusion: MAB+ EBRT+ PPB is extremely effective combination strategy for localized high-risk PCa patients, and PPB plays the important synergistic role in improving PSA kinetics, which are independent predictor for oncologic outcomes.
目的： 探讨前列腺永久植入性近距离治疗(PPB)在改善局限高危前列腺癌(PCa)患者生存预后方面的临床意义。 方法： 回顾性总结接受放疗(RT)联合全雄激素阻断治疗(MAB)的320例局限高危PCa患者的临床资料，分析生存预后因素，并对比PPB对肿瘤预后事件的差异影响。 结果： 全组患者中位随访时间90(12～186)个月，117例(36.6%)患者接受了MAB联合外照射治疗(EBRT)，203例(63.4%)患者接受了MAB＋EBRT＋PPB治疗。多因素分析显示：腺体体积、是否联用PPB、T分期、Gleason评分、基线PSA、高危标准的数量以及PSA动力学特点是总体生存率(OS)和无生化复发生存率(BRFS)的独立预后因素，MAB治疗方式仅是BRFS的独立预后因素。与MAB＋EBRT相比，联用PPB治疗组(MAB＋EBRT＋PPB)能够显著改善PSA动力学特点如下(均P<0.05)：PSA最低值(1.3±0.7)μg/L与(0.11±0.06)μg/L、PSA下降时间(7.5±1.8 )个月与(3.2±2.1)个月、PSA倍增时间(PSADT)为(15.6±4.2)与(22.6±6.1)个月、PSA最大降幅(84.6±6.2)%与(95.8±3.4)%。此外，联用PPB治疗后：中位OS延长3.2年(9.1、12.3年，P<0.001)，PSA生化复发的中位时间被延长3.3年(6.5、9.8年，P<0.001)，骨相关事件(SRE)发生的中位时间被推迟2.2年(8.2、10.4年，P<0.001)，接受细胞毒性药物化疗(CCT)的中位时间被推迟2.8年(8.8、11.6年，P＝0.007)。 结论： RT＋PPB是针对局限高危PCa患者非常有效的一种综合治疗方案，联用PPB能够进一步强化该方案对PSA动力学特点和肿瘤预后事件的有效控制。.
Zhonghua yi xue za zhi. 2017 Jul 11 [Epub]
Y Luo, M C Li, H Z Qi, J H Zhao, Y L Han, Y H Lin, Z Hou, Y G Jiang
Department of Urology, Affiliated Beijing Anzhen hospital of Capital Medical University, Beijing 100029, China.