Background: The efficacy of intermittent androgen deprivation therapy (ADT) for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) is unknown, and its usefulness in Japanese practice needs to be investigated. Methods: We conducted a retrospective analysis of 85 patients who underwent RARP and were selected for intermittent ADT for postoperative recurrence at Kanazawa University Hospital between 2009 and 2019. Intermittent ADT was administered for 2 years. If prostate-specific antigen levels increased post-treatment, intermittent ADT was reinitiated. The median follow-up period was 47 months. Results: The 73 patients had completed the initial course of ADT, and 12 were under initial ADT. The 5-year castration-resistant prostate-cancer-free survival rates, cancer-specific survival, and overall survival were 92.7%, 98.3%, and 94.7%, respectively. A subgroup analysis of 69 patients who completed intermittent ADT was conducted to evaluate the BCR rate following initial ADT. The 5-year BCR-free survival rate was 53.2%. Multivariate analysis identified testosterone ≤ 0.03 ng/mL during ADT as the sole predictor of BCR after ADT. Conclusions: Salvage intermittent ADT may be an effective treatment option for BCR after RARP. In addition, it would be useful to confirm strong testosterone suppression as a criterion for transition to intermittent therapy.
背景：间歇性雄激素剥夺疗法（ADT）对于机器人辅助根治性前列腺切除术（RARP）后生化复发（BCR）的疗效尚不明确，其在日本临床实践中的应用价值有待探讨。方法：本研究回顾性分析了2009年至2019年间在金泽大学医院接受RARP术后复发并选择间歇性ADT治疗的85例患者。间歇性ADT疗程为期2年，若治疗后前列腺特异性抗原水平升高，则重新启动间歇性ADT治疗。中位随访时间为47个月。结果：73例患者已完成初始ADT疗程，12例患者处于初始ADT治疗阶段。5年无去势抵抗性前列腺癌生存率、癌症特异性生存率和总生存率分别为92.7%、98.3%和94.7%。对完成间歇性ADT治疗的69例患者进行亚组分析，评估初始ADT后的BCR发生率。5年无BCR生存率为53.2%。多变量分析显示，ADT期间睾酮水平≤0.03 ng/mL是ADT后BCR的唯一预测因素。结论：挽救性间歇性ADT可能是RARP术后BCR的有效治疗选择。此外，确认强效的睾酮抑制可作为向间歇性治疗过渡的判定标准。
肿瘤(癌症)患者之家