Isotope and patient age predict for PSA spikes after permanent prostate brachytherapy
Isotope and patient age predict for PSA spikes after permanent prostate brachytherapy
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DOI：
10.1016/j.ijrobp.2007.01.066
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发表时间：
2007-08-01
影响因子：
7
通讯作者：
Gutman, Sarah E.
中科院分区：
文献类型：
--
作者：
Bostancic, Chelsea;Merrick, Gregory S.;Gutman, Sarah E.
目的：评价低危患者永久性前列腺近距离放射治疗后前列腺特异性抗原（PSA）峰值的变化。方法和材料：研究人群包括164名前列腺癌患者，他们是一项前瞻性随机试验的一部分，比较103名I和125名低风险疾病。164例患者中，61例（37.2%）接受了短期雄激素剥夺治疗。中位随访时间为5.4年。平均每位患者治疗后获得11.1个PSA测量值。生化无病生存期定义为PSA水平= 0.2 ng/mL，随后持续下降至峰值前水平。多个参数被评估为PSA尖峰的预测因子。结果：164例患者中，44例（26.9%）出现PSA升高。在46例激素初始I-125患者和57例激素初始Pd-103患者中，21例（45.7%）和8例（14.0%）出现PSA峰值。在未接受激素治疗的患者中，I-125和Pd-103患者从植入到峰值的平均时间分别为22.6个月和18.7个月。在接受新辅助雄激素剥夺治疗的患者中，同位素间尖峰的发生率相当（I-125 28.1%和Pd-103 20.7%）。65岁患者的尖峰发生率有很大差异（38.5% vs. 16.3%）。在多变量Cox回归分析中，患者年龄（p < 0.001）和同位素（p = 0.002）是尖峰的显著预测因子。结论：在低危前列腺癌中，PSA峰值最常见于植入125 - 1和/或的患者
Purpose: To evaluate prostate-specific antigen (PSA) spikes after permanent prostate brachytherapy in low-risk patients.Methods and Materials: The study population consisted of 164 prostate cancer patients who were part of a prospective randomized trial comparing 103 I'd and 125, for low-risk disease. Of the 164 patients, 61 (37.2%) received short-course androgen deprivation therapy. The median follow-up was 5.4 years. On average, 11.1 post-treatment PSA measurements were obtained per patient. Biochemical disease-free survival was defined as a PSA level of = 0.2 ng/mL, followed by a durable decline to prespike levels. Multiple parameters were evaluated as predictors for a PSA spike.Results: Of the 164 patients, 44 (26.9%) developed a PSA spike. Of the 46 hormone-naive I-125 patients and 57 hormone-naive Pd-103 patients, 21 (45.7%) and 8 (14.0%) developed a PSA spike. In the hormone-naive patients, the mean time between implantation and the spike was 22.6 months and 18.7 months for I-125 and Pd-103, respectively. In patients receiving neoadjuvant androgen deprivation therapy, the incidence of spikes was comparable between isotopes (I-125 28.1% and Pd-103 20.7 %). The incidence of spikes was substantially different in patients = 65 years old (38.5% vs. 16.3%). On multivariate Cox regression analysis, patient age (p < 0.001) and isotope (p = 0.002) were significant predictors for spike.Conclusion: In low-risk prostate cancer, PSA spikes are most common in patients implanted with 125 1 and/or