Using the magnitude of PSA bounce after MRI-guided prostate brachytherapy to distinguish recurrence, benign precipitating factors, and idiopathic bounce
Using the magnitude of PSA bounce after MRI-guided prostate brachytherapy to distinguish recurrence, benign precipitating factors, and idiopathic bounce
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DOI：
10.1016/s0360-3016(02)03036-5
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发表时间：
2002-11-01
影响因子：
7
通讯作者：
D'Amico, AV
中科院分区：
文献类型：
--
作者：
Das, P;Chen, MH;D'Amico, AV
目的：识别诱发前列腺特异性抗原 (PSA) 反弹的事件，并描述 MRI 引导的前列腺近距离放射治疗后 PSA 反弹的幅度、持续时间和时间。方法和材料：1997 年至 2001 年间，186 名低危前列腺癌患者接受了 MRI 引导的永久性 1251 源植入，有或没有外照射放疗。 PSA 反弹被定义为 PSA 与最近的值相比升高大于或等于 15%，随后下降至反弹前值或以下的水平。在 PSA 测量时，前瞻性地收集患者近期是否有射精、持续的放射性直肠炎或近期使用仪器的数据。 结果：共有 115 名患者 (61.8%) 总共有 156 次 PSA 反弹。其中，36 名患者出现与射精、直肠炎或器械相关的 PSA 反跳，79 名患者经历特发性 PSA 反跳（与诱发事件无关）。与射精 (p = 0.003)、直肠炎 (p < 0.0001) 或器械检查 (p = 0.007) 相关的 PSA 反弹幅度相比，特发性 PSA 反弹 (0.6 ng/mL) 的 PSA 反弹幅度明显较低。经活检证实局部复发的患者 PSA 中值升高为 1.2 ng/mL，显着高于特发性 PSA 反弹的幅度 (p = 0.006)，但与射精、直肠炎或器械引起的 PSA 反弹幅度没有显着差异。 结论：在接受 MRI 引导的前列腺近距离放射治疗的患者中，近期射精、器械或持续的放射性直肠炎可导致PSA，其幅度明显高于特发性 PSA 反弹，但与复发性疾病患者相似。 (C) 2002 爱思唯尔科学公司。
Purpose: To identify events that precipitated a prostate-specific antigen (PSA) bounce and characterize the magnitude, duration, and time to PSA bounce after MRI-guided prostate brachytherapy.Methods and Materials: Between 1997 and 2001, 186 patients with low-risk prostate cancer underwent MRI-guided permanent 1251 source implantation, with or without external beam radiotherapy. A PSA bounce was defined as a greater than or equal to 15% elevation in PSA compared with the most recent value, followed by a decline to a level at or less than the prebounce value. At the time of PSA measurement, data were prospectively collected on whether the patient had recent ejaculation, ongoing radiation proctitis, or recent instrumentation.Results: A total of 115 patients (61.8%) had a total of 156 PSA bounces. Of these, 36 patients had PSA bounces associated with ejaculation, proctitis, or instrumentation, and 79 experienced idiopathic PSA bounces (not associated with a precipitating event). The magnitude of the PSA bounce was significantly lower for the idiopathic PSA bounce (0.6 ng/mL) compared with that associated with ejaculation (p = 0.003), proctitis (p < 0.0001), or instrumentation (p = 0.007). Patients with biopsy-proven local recurrence had a median PSA elevation of 1.2 ng/mL, significantly higher (p = 0.006) than the magnitude of the idiopathic PSA bounce, but not significantly different from the magnitude of the PSA bounce due to ejaculation, proctitis, or instrumentation.Conclusion: In patients treated with MRI-guided prostate brachytherapy, recent ejaculation, instrumentation, or ongoing radiation proctitis can cause a transient increase in PSA, the magnitude of which is significantly higher than that for idiopathic PSA bounce, but is similar to that in patients with recurrent disease. (C) 2002 Elsevier Science Inc.