Departmental Bulletin Paper Initial PSA 100 ng/ml 以上の非転移性前立腺癌に対する局所治療の有用性の検討 : 多施設共同後ろ向き研究
Availability of Local Therapy to Castration-Resistant Prostate Cancer for M0 Patients with Initial Prostate Specific Antigen 100 ng/ml or Higher

黒本, 暁人  ,  田中, 峻希  ,  小山, 淳太朗  ,  後藤, 拓郎  ,  木村, 信吾  ,  勝又, 有記  ,  明円, 真吾  ,  小澤, 迪喜  ,  諸角, 謙人  ,  佐藤, 真彦  ,  星, 宣次  ,  沼畑, 健司  ,  荒井, 陽一

63 ( 12 )  , pp.515 - 520 , 2017-12-31 , 泌尿器科紀要刊行会
Prostate cancer patients with initial PSA 100 ng/ml or greater who received transrectal ultrasoundguided prostate biopsy and were staged as M0 by imaging studies from 2011 to 2014 in seven hospitals, were enrolled in the study. Castration-resistant prostate cancer (CRPC)-free survival was compared between the two treatment groups : androgen deprivation therapy (ADT) alone and ADT plus local therapy. Of 142 prostate cancer patients with initial PSA 100 ng/ml or greater, 49 (34.5%) had no metastases and final analysis was performed on 46 patients. Thirty one M0 patients received ADT alone, and 15 received ADT plus local therapy. During follow-up (median 31 months, range 1-56 months) 13 patients (42%) in the ADT alone group progressed to CRPC. One- and two-year CRPC-free survival rates were 72.5 and 53%, respectively. No patients with ADT plus local therapy developed CRPC, and time to CRPC was prolonged significantly (p=0.002). On multivariate analysis for the group with ADT alone, PSA nadir of more than 0. 2 ng/ml and cN1 were independent predictors for progression to CRPC (p=0.009, 0.031). About one third of prostate cancer patients with initial PSA 100 ng/ml or greater had clinically no metastases. Local therapy to prostate combined with ADT may prolong time to CRPC compared with ADT alone. A subset of men with a PSA nadir of more than 0.2 ng/ml after ADT and cN1 could benefit from local therapy.

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