PSA kinetics and PSA bounce following permanent seed prostate brachytherapy
PSA kinetics and PSA bounce following permanent seed prostate brachytherapy
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DOI：
10.1016/j.ijrobp.2007.03.031
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发表时间：
2007-10-01
影响因子：
7
通讯作者：
Lockwood, Gina
中科院分区：
文献类型：
--
作者：
Crook, Juanita;Gillan, Caitlin;Lockwood, Gina
目的：报告 I-125 前列腺近距离放射治疗后良性前列腺特异性抗原 (PSA) 反弹的发生率、时间和幅度，并将反弹与临床和/或剂量因素相关联。方法和材料：从 1999 年 3 月到 2003 年 8 月，共有 292 名男性接受了 I-125 前列腺近距离治疗，没有雄激素剥夺或补充束放疗，并且 PSA 随访 > 30 个月。使用经直肠超声 (TRUS) 预先计划植入物，并使用预装针在经直肠超声/透视引导下进行。 PSA 反弹定义为增加 >= 0.2 ng/ml，并自发恢复至反弹前水平或更低。结果：随访 > 30 个月后，40% 的男性 PSA 反弹得到解决。中位发病时间为 15 个月，中位强度为 0.76 ng/ml。 15% 的患者数量级 > 2 ng/ml。在多变量分析中预测反弹的唯一临床或剂量学因素是年轻。表明失败的 PSA 水平升高的中位时间为 30 个月。结论：I-125 前列腺近距离放射治疗后，良性 PSA 反弹很常见，尤其是在年轻男性中。 15% 的患者比最低点增加了 > 2 ng/ml。增加的幅度并不能区分反弹和失败。 PSA 开始增加的时间可能会有帮助，但不是绝对的。 PSA 的反弹并不预示着随后的失败。建议谨慎解释高危患者 I-125 近距离放射治疗后前 30 个月内早期升高的 PSA 水平。 (c) 2007 爱思唯尔公司
Purpose: To report the incidence, timing, and magnitude of the benign prostate-specific antigen (PSA) bounce after I-125 prostate brachytherapy and correlate the bounce with clinical and/or dosimetric factors. Methods and Materials: From March 1999 to August 2003, a total of 292 men received I-125 prostate brachytherapy without androgen deprivation or supplemental beam radiotherapy and have PSA follow-up > 30 months. Implants were preplanned using transrectal ultrasound (TRUS) and performed under transrectal ultrasound/fluoroscopy guidance using preloaded needles. A PSA bounce is defined as an increase >= 0.2 ng/ml with spontaneous return to prebounce level or lower. Results: Resolved PSA bounces were seen in 40% of men with follow-up > 30 months. Median onset was 15 months, and median magnitude was 0.76 ng/ml. Magnitude > 2 ng/ml was seen in 15%. The only clinical or dosimetric factor predictive of bounce in multivariate analysis was younger age. Median time to increasing PSA level indicative of failure was 30 months. Conclusions: Benign PSA bounces are common after I-125 prostate brachytherapy, especially in younger men. An increase > 2 ng/ml above the nadir was seen in 15%. Magnitude of increase does not distinguish bounce from failure. Time to the start of the PSA increase can be helpful, but is not absolute. The PSA bounce does not predict subsequent failure. Caution is advised in interpreting an early increasing PSA level in the first 30 months after I-125 brachytherapy in favorable-risk patients. (c) 2007 Elsevier Inc.