Defining biochemical recurrence after radical prostatectomy and timing of early salvage radiotherapy: Informing the debate; [Definition eines biochemischen Rezidiv nach radikaler Prostatektomie und Initiierung einer frühen Salvage-Strahlentherapie: Informationen zur Debatte]

被引：0
作者：
Budäus L. [1 ]
Schiffmann J. [1 ]
Graefen M. [1 ]
Huland H. [1 ]
Tennstedt P. [1 ]
Siegmann A. [2 ]
Böhmer D. [2 ]
Budach V. [2 ]
Bartkowiak D. [3 ]
Wiegel T. [3 ]
机构：
[1] Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg
[2] Department of Radiation Oncology, Charité University Hospital, Berlin
[3] Department of Radiation Oncology, University Hospital Ulm, Ulm
来源：
Strahlentherapie und Onkologie | 2017年 / 193卷 / 9期
关键词：
Neoplasm metastasis; Prostate cancer; Prostate-specific antigen; Radiotherapy; adjuvant; Survival;
D O I：
10.1007/s00066-017-1140-y
中图分类号：
学科分类号：
摘要：
Background: The optimal prostate-specific antigen (PSA) level after radical prostatectomy (RP) for defining biochemical recurrence and initiating salvage radiation therapy (SRT) is still debatable. Whereas adjuvant or extremely early SRT irrespective of PSA progression might be overtreatment for some patients, SRT at PSA >0.2 ng/ml might be undertreatment for others. The current study addresses the optimal timing of radiation therapy after RP. Patients and methods: Cohort 1 comprised 293 men with PSA 0.1–0.19 ng/ml after RP. Cohort 2 comprised 198 men with SRT. PSA progression and metastases were assessed in cohort 1. In cohort 2, we compared freedom from progression according to pre-SRT PSA (0.03–0.19 vs. 0.2–0.499 ng/ml). Multivariable Cox regression analyses predicted progression after SRT. Results: In cohort 1, 281 (95.9%) men had further PSA progression ≥0.2 ng/ml and 27 (9.2%) men developed metastases within a median follow-up of 74.3 months. In cohort 2, we recorded improved freedom from progression according to lower pre-SRT PSA (0.03–0.19 vs. 0.2–0.499 ng/ml: 69 vs. 53%; log-rank p = 0.051). Patients with higher pre-SRT PSA ≥0.2 ng/ml were at a higher risk of progression after SRT (hazard ratio: 1.8; p < 0.05). Conclusion: The vast majority of patients with PSA ≥0.1 ng/ml after RP will progress to PSA ≥0.2 ng/ml. Additionally, early administration of SRT at post-RP PSA level <0.2 ng/ml might improve freedom from progression. Consequently, we suggest a PSA threshold of 0.1 ng/ml to define biochemical recurrence after RP. © 2017, Springer-Verlag Berlin Heidelberg.
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页码：692 / 699
页数：7
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共 32 条
  • [1] Han M., Partin A.W., Zahurak M., Piantadosi S., Epstein J.I., Walsh P.C., Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer, J Urol, 169, 2, pp. 517-523, (2003)
  • [2] Ploussard G., Staerman F., Pierrevelcin J., Saad R., Beauval J.B., Roupret M., Audenet F., Peyromaure M., Delongchamps N.B., Vincendeau S., Fardoun T., Rigaud J., Villers A., Bastide C., Soulie M., Salomon L., Predictive factors of oncologic outcomes in patients who do not achieve undetectable prostate specific antigen after radical prostatectomy, J Urol, 190, 5, pp. 1750-1756, (2013)
  • [3] Stephenson A.J., Scardino P.T., Eastham J.A., Bianco F.J., Dotan Z.A., Fearn P.A., Kattan M.W., Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy, J Natl Cancer Inst, 98, 10, pp. 715-717, (2006)
  • [4] Cotter S.E., Chen M.H., Moul J.W., Lee W.R., Koontz B.F., Anscher M.S., Robertson C.N., Walther P.J., Polascik T.J., D'Amico A.V., Salvage radiation in men after prostate-specific antigen failure and the risk of death, Cancer, 117, 17, pp. 3925-3932, (2011)
  • [5] Katz M.S., Zelefsky M.J., Venkatraman E.S., Fuks Z., Hummer A., Leibel S.A., Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer, J Clin Oncol, 21, 3, pp. 483-489, (2003)
  • [6] Stephenson A.J., Scardino P.T., Kattan M.W., Pisansky T.M., Slawin K.M., Klein E.A., Anscher M.S., Michalski J.M., Sandler H.M., Lin D.W., Forman J.D., Zelefsky M.J., Kestin L.L., Roehrborn C.G., Catton C.N., DeWeese T.L., Liauw S.L., Valicenti R.K., Kuban D.A., Pollack A., Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy, J Clin Oncol, 25, 15, pp. 2035-2041, (2007)
  • [7] Trock B.J., Han M., Freedland S.J., Humphreys E.B., DeWeese T.L., Partin A.W., Walsh P.C., Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy, JAMA, 299, 23, pp. 2760-2769, (2008)
  • [8] Song C., Kang H.C., Kim J.S., Eom K.Y., Kim I.A., Chung J.B., Hong S.K., Byun S.S., Lee S.E., Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy: a propensity score-matched analysis, Strahlenther Onkol, 191, 10, pp. 801-809, (2015)
  • [9] Cookson M.S., Aus G., Burnett A.L., Canby-Hagino E.D., D'Amico A.V., Dmochowski R.R., Eton D.T., Forman J.D., Goldenberg S.L., Hernandez J., Higano C.S., Kraus S.R., Moul J.W., Tangen C., Thrasher J.B., Thompson I., Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes
  • [10] Heidenreich A., Bastian P.J., Bellmunt J., Bolla M., Joniau S., van der Kwast T., Mason M., Matveev V., Wiegel T., Zattoni F., Mottet N., EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer, Eur Urol, 65, 2, pp. 467-479, (2014)
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