Extended Follow-Up of Patients with Stage T2a Prostate Adenocarcinoma After Outpatient Conformal Brachytherapy: Risk Stratification for Treatment Optimization

S. Sundararaman, D. Nori, S. Parikh, J. Moni, A. Osian, C. Wilson
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引用次数: 1

Abstract

Brachytherapy is an excellent definitive treatment modality for select patients with localized prostate cancer. Sixty-four patients with Stage T2a prostate adenocarcinoma were identified from the series of prostate patients receiving conformal outpatient brachytherapy between 1990 and 1997. Pretreatment Gleason scores and prostate specific antigen (PSA) values ranged from 2 to 10 and 1.5 to 100, respectively. Median follow-up was 48.5 months. The 5-year overall survival rate was 82.5%, whereas the cause-specific survival rate was 93.7%. The biochemical freedom-from-relapse (bFFR), defined as a PSA level of ≤ 1.0 for patients presenting with Gleason scores of ≤ 5, was 68%; 80% with Gleason scores of ≤ 5 and presenting PSA levels of ≤ 10. In patients with Gleason scores of 6 at presentation, the overall bFFrR was 67%; 87% with a Gleason scores of 6 and PSA levels of ≤ 10. The bFFR was maintained in more than half of patients with Gleason scores of 7 only if they presented with PSA levels of ≤ 10. All patients who presented with PSA levels of ≤ 10 had bFFRs of 75%, compared to 36% for those patients presenting with PSA levels of > 10. These data show that patients with Gleason scores of ≤ 5 can achieve very good PSA control with brachytherapy, especially if the presenting PSA level is ≤ 10. Consideration of PSA is of greater import when a Gleason score ≥ 6 is encountered at presentation. Our data show that durable bFFR can be achieved in patients presenting with Stage T2a disease, Gleason scores of 5–7, and PSA levels of ≤ 10. These results need to be confirmed with further follow-up and other prospective data.
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门诊适形近距离放射治疗后T2a期前列腺癌患者的延长随访:优化治疗的风险分层
对于局部前列腺癌患者,近距离放射治疗是一种极好的决定性治疗方式。从1990年至1997年间接受适形门诊近距离放射治疗的前列腺患者中鉴定出64例T2a期前列腺癌患者。预处理Gleason评分和前列腺特异性抗原(PSA)值分别为2 ~ 10和1.5 ~ 100。中位随访时间为48.5个月。5年总生存率为82.5%,病因特异性生存率为93.7%。生化无复发自由度(bFFR)为68%,定义为Gleason评分≤5的患者PSA水平≤1.0;80% Gleason评分≤5,PSA水平≤10。在就诊时Gleason评分为6的患者中,总bFFrR为67%;87%的患者Gleason评分为6,PSA水平≤10。超过一半Gleason评分为7分的患者,只有当PSA水平≤10时,bFFR才能维持。所有PSA水平≤10的患者的bffr为75%,而PSA水平为bbb10的患者为36%。这些数据表明,Gleason评分≤5的患者在近距离治疗中可以很好地控制PSA,特别是当目前的PSA水平≤10时。当就诊时Gleason评分≥6时,PSA的考虑更为重要。我们的数据显示,对于T2a期疾病、Gleason评分为5-7分、PSA水平≤10的患者,可以实现持久的bFFR。这些结果需要进一步的随访和其他前瞻性数据来证实。
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