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Guide
Many patients with advanced prostate cancer eventually require multimodal therapy, which typically includes radiation therapy after radical prostatectomy and/or hormonal therapy
with biochemical recurrence (BCR).
Some patients have a second biochemical recurrence (sBCR)
after radical prostatectomy and salvage radiotherapy (sRT).
There is currently a lack of research on the significance or role of sBCR, so foreign researchers conducted a study to evaluate the value
of sBCR on patient outcomes.
The medical pulse is organized as follows
.
Most patients respond well to salvage radiation therapy after radical prostatectomy, but sBCR
is still followed by about 44% to 67.
9% of patients.
BCR after radical prostatectomy has been shown to be associated with different tumour control outcomes, but no studies have clarified the significance and role of
sBCR after sRT in patients undergoing radical prostatectomy.
Therefore, the investigators hypothesized that sBCR in patients over a short period of time was associated with poor tumor control, and validated it as a predictor of prostate-specific death in patients who underwent sRT after failed radical prostatectomy
.
The researchers performed a post-hoc
analysis of the data from the RTOG 9601 trial.
The RTOG 9601 trial included 760 patients with prostate cancer with tumor stages pT2/T3 and pN0, where prostate-specific antigen (PSA) levels continued to rise after prostatectomy or developed BCR (0.
2-4.
0 ng/ml
).
All patients received sRT (with or without bicalutamide), and all patients with sBCR received salvage hormone therapy
.
The investigators focused on 421 patients who developed sBCR (defined as a decrease in PSA levels of at least 0.
2 ng/ml from the first nadir point) after receiving sRT.
Patients were divided into early (≤ 3.
51 years) and late (>3.
51 years) according to the median time to sBCR onset (3.
51 years), and the effect
of sBCR onset on tumor-specific death (CSM) was compared.
The primary endpoint was prostate cancer-specific death
.
A total of 421 patients developed sBCR after receiving sRT, 75.
8% were ≥ 60 years old, 74.
8% of patients with pT3 stage, and most (75.
2%) patients had a Gleason score of 7
.
Postoperative PSA persisted in 13.
8% of patients
.
Patients were divided into groups according to the median sBCR occurrence time, with 210 cases in the early group and 211 cases
in the late group.
Patient data are shown in Table 1
.
Table 1 Comparison of basic data of the two groups
The investigators used the cumulative association function to compare CSM
between the two groups.
The study found that in patients who developed sBCR, the 5-year and 10-year CSM rates were 8% (95% CI 5%-11%) and 27% (95% CI 22%-32%)
, respectively.
At 10 years, the 5-year and 10-year CMS rates in the early and late groups were 11.
2% vs 4.
27% and 31.
3% vs 20.
0%, respectively (p=0.
03, Figure 1).
Fig.
1 Cumulative incidence of prostate cancer-specific death in different groups
The results of multivariate competitive risk analysis showed that the time of onset of sBCR was an independent predictor
of CSM in prostate cancer.
The data showed that patients with earlier sBCR had a 1.
69-fold risk of CSM than patients with later sBCR (HR=1.
69, 95% CI 1.
07-2.
69, p=0.
02).
Table 2 Results of multivariate Cox regression analysis of CSM influencing factors
When the time of sBCR occurrence was statistically analyzed as a continuous variable (Table 3), the time of sBCR occurrence could still be used as a predictor of CSM in prostate cancer (p=0.
006).
Table 3 Results of multivariate Cox regression analysis of CSM influencing factors (sBCR occurrence time as continuous variable)
conclusionThe time after sRT to the onset of sBCR in patients undergoing radical prostatectomy is an important predictor
of CSM.
This information can predict the patient's prognosis and provide a reference
for the patient's subsequent treatment.
It is expected that this result will be validated in subsequent prospective studies and the optimal stratification
of patients will be determined.
References
Brodowsky EC, Sood A, Butaney M, Majdalany SE, Stephens A, Corsi N, Piontkowski AJ, Rakic I, Jamil M, Dalela D, Peabody JO, Rogers CG, Abdollah F.
Time to second biochemical recurrence as a prognostic indicator in postprostatectomy patients who undergo salvage radiation therapy: An RTOG 9601 based post hoc analysis.
Prostate.
2022 Sep 19.
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