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KMID : 0939920220540041191
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대한암학회지
2022 Volume.54 No. 4 p.1191 ~ p.1199
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Optimal Definition of Biochemical Recurrence in Patients Who Receive Salvage Radiotherapy Following Radical Prostatectomy for Prostate Cancer
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Lee Sung-Uk
Kim Jae-Sung
Kim Young-Seok
Cho Jae-Ho
Choi Seo-Hee
Nam Taek-Keun
Jeong Song-Mi
Kim Young-Kyong
Choi Young-Min
Lee Dong-Eun
Park Won
Cho Kwan-Ho
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Abstract
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Purpose: This study proposed the optimal definition of biochemical recurrence (BCR) after salvage radiotherapy (SRT) following radical prostatectomy for prostate cancer.
Materials and Methods: Among 1,117 patients who had received SRT, data from 205 hormone-naive patients who experienced post-SRT prostate-specific antigen (PSA) elevation were included in a multi-institutional database. The primary endpoint was to determine the PSA parameters predictive of distant metastasis (DM). Absolute serum PSA levels and the prostate-specific antigen doubling time (PSA-DT) were adopted as PSA parameters.
Results: When BCR was defined based on serum PSA levels ranging from 0.4 ng/mL to nadir+2.0 ng/mL, the 5-year probability of DM was 27.6%?33.7%. The difference in the 5-year probability of DM became significant when BCR was defined as a serum PSA level of 0.8 ng/ml or higher (1.0?2.0 ng/mL). Application of a serum PSA level of ≥ 0.8 ng/mL yielded a c-index value of 0.589. When BCR was defined based on the PSA-DT, the 5-year probability was 22.7%?39.4%. The difference was significant when BCR was defined as a PSA-DT ≤ 3 months and ≤ 6 months. Application of a PSA-DT ≤ 6 months yielded the highest c-index (0.660). These two parameters complemented each other; for patients meeting both PSA parameters, the probability of DM was 39.5%?44.5%; for those not meeting either parameter, the probability was 0.0%?3.1%.
Conclusion: A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT. In addition, a PSA-DT ≤ 6 months was significantly predictive of subsequent DM, and combined application of both parameters enhanced predictability.
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KEYWORD
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Prostatic neoplasms, Prostatectomy, Radiotherapy, Prostate-specific antigen
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