Prostate-specific antigen bounce after prostate seed implantation for localized prostate cancer: Descriptions and implications
Prostate-specific antigen bounce after prostate seed implantation for localized prostate cancer: Descriptions and implications
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DOI：
10.1016/s0360-3016(02)04470-x
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发表时间：
2003-06-01
影响因子：
7
通讯作者：
Cesaretti, JA
中科院分区：
文献类型：
--
作者：
Stock, RG;Stone, NN;Cesaretti, JA
目的：使用文献中提到的三种弹跳的定义，计算单独接受前列腺近距离放射治疗后发生前列腺特异性抗原(PSA)弹跳的精算风险，并探讨疾病和治疗变量与发生弹跳的风险之间的关系。方法与材料：373例T1-T2期前列腺癌患者在未接受激素治疗或外照射的情况下，分别采用I-125(n=337)或PD-103(n=36)进行放射性粒子植入治疗。所有患者都有至少1年(中位数4，最大11)的随访和至少3次随访的PSA值。PSA反弹的定义是，PSA值上升一到两个，然后下降。使用了三种反弹的定义：定义1，上升大于或等于0.1 ng/m L；定义2，上升大于或等于0.4 ng/m L；以及定义3，上升与前值的35%。结果：定义1发生PSA反弹的精算可能性为31%，定义2为17%，定义3为20%。定义1和定义2发生反弹的中位时间为19.5个月，定义3为20.5个月。Gleason评分、初始PSA水平和临床分期不能用任何定义预测反弹。使用定义1，年轻患者(565岁)在5年时的反跳率为38%，而老年患者为24%(p=0.009)。接受小于或等于160GY植入剂量的I-125患者在5年内的弹跳率(定义1)为24%，而那些接受植入后1个月剂量-体积直方图(D-90)和160GT；160GY(p=0.04)的剂量达到90%的患者的弹跳率为38%。使用定义2，前列腺体积显著影响反弹的发生率。腺体较大(35厘米(3))的患者比腺体较小(小于或等于35厘米(3))的患者更有可能在5年内经历反弹(23%)，后者在5年内的弹跳率为11%(P=0.01)。在预测PSA失败因素的多变量分析中，PSA反弹并不显著。结论：PSA反弹是前列腺近距离放射治疗后的常见现象，根据所用定义的不同，PSA反弹的发生率为17-31%。这在较年轻的患者、接受较高植入剂量的患者和腺体较大的患者中更为常见。PSA反弹不能预测未来的PSA故障。(C)2003年爱思唯尔公司。
Purpose: To calculate the actuarial risk of developing a prostate-specific antigen (PSA) bounce after prostate brachytherapy alone, using three definitions of bounce mentioned in the literature, and to explore the relationship between disease and treatment variables and the risk of developing a bounce. The impact of PSA bounce on PSA failure was also explored.Methods and Materials: A total of 373 patients with T1-T2 prostate cancer underwent radioactive seed implant Using I-125 (n = 337) or Pd-103 (n = 36) without hormonal therapy or external beam RT. All patients had a minimum of I year (median 4, maximum 11) of follow-up and at least three follow-up PSA values. PSA bounce was defined by a rise of one or two PSA values with a subsequent fall. Three definitions of bounce were used: definition 1, rise greater than or equal to0.1 ng/mL; definition 2, rise greater than or equal to0.4 ng/mL; and definition 3, rise >35% of previous value.Results: The actuarial likelihood of experiencing a PSA bounce at 5 years was 31% for definition 1, 17% for definition 2, and 20% for definition 3. The median time to develop a bounce was 19.5 months for definitions 1 and 2 and 20.5 months for definition 3. Gleason score, initial PSA level, and clinical stage did not predict for bounce using any definition. Using definition 1, younger patients (565 years) had a bounce rate at 5 years of 38% vs. 24% for older patients (p = 0.009). I-125 patients receiving an implant dose of less than or equal to160 Gy had a bounce rate (definition 1) at 5 years of 24% vs. 38% for those receiving a dose delivered to 90% of the gland on the 1 month postimplant dose-volume histogram (D-90) >160 Gy (p = 0.04). Using definition 2, prostate volume significantly affected the incidence of bounce. Patients with larger glands (>35 cm(3)) were more likely to experience a bounce (23% at 5 years) than those with smaller glands (less than or equal to35 cm(3)) who had a bounce rate of 11% at 5 years (P = 0.01). In a multivariate analysis of factors predicting for PSA failure, PSA bounce was not found to be significant.Conclusion: PSA bounce is a common phenomenon after prostate brachytherapy and occurs at a rate of 17-31 %, depending on the definition used. It is more common in younger patients, those receiving higher implant doses, and those with larger glands. PSA bounce does not predict for future PSA failure. (C) 2003 Elsevier Inc.