高風險攝護腺癌接受賀爾蒙併放射性治療與根除性攝護腺切除手術預後分析

李柏毅、蔡禮賢、黃志平、張兆祥、吳錫金、楊啟瑞

中國醫藥大學附設醫院 泌尿部

Comparison of oncological results in high risk group prostate patients between combined radiotherapy with hormone therapy and radical prostatectomy  

Po-I,Li , Li-Hsien Tsai , Chi-Ping,Huang , Chao-Hsiang Chang , His-Chin Wu , Chi-Rei Yang  

China Medical University Hospital, Taichung, Taiwan

Purpose: Prostate cancer (PCa) is one of the most common male malignancy in the Western countries. Patients with high-risk PCa are at significant risk of biochemical failure, distant metastasis, and increased disease-specific mortality rate. Optimal treatment approaches for high-risk PCa remain controversial and there are currently no standard treatments. In the past, These group of patients are usually offered radiotherapy in combination with hormonal therapy. However, lots of study also report excellent outcome for radical prostatectomy alone. Therefore, this study aims to report oncological results in high-risk PCa patients from the single medical center.

Materials and Methods: Patients presented with high-risk PCa according to NCCN guideline at the single medical center from 2010/01 to 2020/12 was involved. We analyzed patient characteristics, prostate-specific antigen (PSA), cancer staging, biochemical recurrence (BCR) free survival, disease-specific survival, and the pattern of secondary hormone therapy and chemotherapy usage. The patient received radical prostatectomy (RP) with bilateral pelvic lymph node dissection or radiotherapy plus hormone therapy (RT/HT). RT/HT group patients received RT total dosage 7500 to 8000 cGy with additional 2 to 3 years hormone therapy. All patients received regular follow-up with PSA at least three months again during the first year, six months since the second year then annually monitoring. PSA exceeds 0.2 after RP was recorded as the biochemical failure. We used Phoenix criteria to define BCR after RT/HT.

Results: A total 1906 Pca patients were treated from single medical center. 318 (47%) patients were categorized as high-risk according to NCCN guideline. 165 patients received RT/HT, and 153 patients received RP. RT/HT group patients are significantly older and present with higher PSA. Clinical T-stage and Gleason score were similar between two groups. The 5-year BCR-free survival improved significantly for patients who received RT/HT compared to those who received RP (RT/HT vs RP, 84.8 vs 56.2%, P<0.001). There was no significant difference between 5-year overall survival(77.6 vs 92.8%) and disease-specific survival (92.1 vs 99.3%) between two groups.

Conclusions:  No different of overall survival and disease-specific survival was found between two groups. However, BCR probabilities and need for secondary treatment were significantly higher in RP group. This may be due to different BCR definition between RT/HT and RP groups.  Among patients treated with RP, a marked heterogeneity existed in the oncological outcomes. The number and character of high-risk group factors should be emphasized to decide the optimal treatments for patients with high-risk PCa. The long-term oncological outcome for high-risk group patients between RT/HT and RP was satisfactory. RP may be a more actively considered option for selected high-risk PCa patients.