Prostate-specific antigen (PSA) nadir and experience of PSA bounce after low-dose-rate brachytherapy for prostate cancer predicts clinical failure

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-11-01 DOI:10.1016/j.brachy.2024.09.003

Yasushi Nakai , Nobumichi Tanaka , Isao Asakawa , Kenta Onishi , Makito Miyake , Kaori Yamaki , Kiyohide Fujimoto

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引用次数: 0

Abstract

OBJECTIVE

This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels.

METHODS

This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively.

RESULTS

Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels >0.2 or >0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA <0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR.

CONCLUSIONS

Patients with normal serum testosterone levels who reached PSA of <0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control.

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前列腺特异性抗原 (PSA) 最低值和低剂量近距离放射治疗前列腺癌后 PSA 反弹的经验可预测临床失败。

研究目的本研究旨在评估前列腺特异性抗原（PSA）阈值和 PSA 反弹是否与单独使用低剂量近距离放射治疗（LDR-BT）或与外照射放疗（EBRT）、使用或不使用雄激素剥夺疗法（ADT）后的肿瘤控制有关，同时考虑血清睾酮水平：这项研究共纳入了在一家医疗机构接受单独 LDR-BT 或 LDR-BT 联合 EBRT 治疗的 944 名前列腺癌患者，无论患者是否接受 ADT 治疗。采用Fine-Gray危险模型评估与临床失败相关的因素，包括基线与LDR-BT后2、4或7年之间PSA反弹的经历，以及LDR-BT后2、4和7年时睾酮水平正常的PSA值（0.1、0.2或0.5纳克/毫升）：结果：在LDR-BT术后2年、4年和7年，睾酮水平正常且PSA为0.2或0.5纳克/毫升的患者的临床无失败率（CFFR）明显高于PSA水平>0.2或>0.5纳克/毫升或睾酮水平低的患者。多变量分析显示，PSA血清睾酮水平正常的患者，如果 PSA 达到

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.