In patients with prostate cancer (PCa), salvage radiotherapy (SRT) for biochemical progression (BP) after radical prostatectomy (RP) improves PCa-specific survival. However, no prospective randomized trials have compared the effect of SRT with untreated patients. In this analysis of 151 patients who received SRT for post-RP BP, we compared their overall survival (OS) with virtual, age-matched controls (n= 151,000) retrieved from government life tables. We also investigated the risk factors associated with BP and OS and compared the prostate-specific antigen (PSA) doubling times (DTs) before and after SRT for patients with BP. The median follow-up was 9.3 years for BP and 17.4 years for OS. The risk factors significantly affecting BP were Gleason score (p< 0.001), pre-SRT PSA (p= 0.003), and negative surgical margins (p= 0.003). None of these risk factors were associated with OS. In 93 patients with BP after SRT, the median PSADT was significantly prolonged compared with pre-SRT values (3.7 vs. 8.3 months,p< 0.001). The OS did not differ between patients and controls (p= 0.112), and life expectancy was similar, likely due to the survival benefit of SRT. The prolonged PSADT after SRT further supports the beneficial role of SRT in this patient population. However, subsequent treatments were not systematically recorded, which may have affected the results.
在前列腺癌患者中，针对根治性前列腺切除术后生化进展的挽救性放疗可改善疾病特异性生存。然而目前尚无前瞻性随机试验比较挽救性放疗与未治疗患者的疗效差异。本研究对151例接受挽救性放疗的术后生化进展患者进行分析，将其总生存期与从政府生命表中提取的年龄匹配虚拟对照组（n=151,000）进行比较。同时探究了与生化进展及总生存期相关的风险因素，并对比了生化进展患者放疗前后前列腺特异性抗原倍增时间的变化。生化进展中位随访时间为9.3年，总生存期中位随访时间为17.4年。显著影响生化进展的风险因素包括格里森评分（p<0.001）、放疗前前列腺特异性抗原水平（p=0.003）以及手术切缘阴性（p=0.003），但这些因素均与总生存期无显著关联。在93例放疗后出现生化进展的患者中，中位前列腺特异性抗原倍增时间较放疗前显著延长（3.7个月 vs 8.3个月，p<0.001）。患者组与对照组的总生存期无统计学差异（p=0.112），预期寿命相近，这可能得益于挽救性放疗带来的生存获益。放疗后前列腺特异性抗原倍增时间的延长进一步支持了挽救性放疗对该患者群体的积极作用。但需注意，后续治疗缺乏系统记录可能对研究结果产生影响。
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