文章：

PSA最低值+2 ng/mL是否总是提示生化复发？基于PSA动力学的碳离子放疗后局部高危前列腺癌评估

Does PSA Nadir + 2 ng/mL Always Indicate Biochemical Recurrence? A PSA Kinetics-Based Evaluation Following Carbon Ion Radiotherapy for Localized High-Risk Prostate Cancer

原文发布日期：31 August 2025

DOI: 10.3390/cancers17172867

类型: Article

开放获取: 是

英文摘要：

Background:Biochemical recurrence after radiotherapy for prostate cancer is commonly defined by the Phoenix criteria (prostate-specific antigen [PSA] nadir + 2 ng/mL). However, some patients experience PSA elevation without clinical recurrence, which is known as PSA bounce. This study aimed to evaluate PSA kinetics after scanning-method carbon ion radiotherapy (CIRT) in patients with high-risk prostate cancer (HR-PCa) and to assess the clinical validity of the Phoenix criteria.Methods:We retrospectively analyzed 171 patients with HR-PCa who underwent CIRT and 2 years of androgen deprivation therapy. Patients were classified into three groups based on post-treatment PSA kinetics: non-recurrence, pseudo-recurrence (PR; PSA > 2 ng/mL followed by spontaneous decline without salvage therapy), and recurrence (R; PSA > 2 ng/mL with salvage therapy). PSA bounce was defined as a transient PSA increase > 0.4 ng/mL followed by spontaneous decline. Kaplan–Meier and receiver operating characteristic (ROC) analyses were used to evaluate biochemical relapse-free survival and determine the optimal PSA cutoff.Results:Among 171 patients, 18 (10.5%) met the Phoenix criteria (R+PR), of whom 6 (33.3%) experienced spontaneous PSA decline. The 5-year biochemical relapse-free survival rate was 90.0%. PSA bounce occurred in 33.9%. ROC analysis identified an optimal PSA cutoff of 1.91 ng/mL (area under the curve: 0.985), whereas the positive predictive value at the 2 ng/mL cutoff was as low as 61.1% due to the influence of PSA bounce.Conclusions:After CIRT, a PSA rise of >2 ng/mL does not always indicate HR-PCa recurrence and should be interpreted with caution to avoid overtreatment.

摘要翻译： 

背景：前列腺癌放疗后生化复发的判定通常采用凤凰标准（前列腺特异性抗原[PSA]最低值+2 ng/mL）。然而，部分患者会出现无临床复发的PSA升高现象，即PSA反弹。本研究旨在评估高危前列腺癌患者接受扫描式碳离子放疗后的PSA动力学特征，并验证凤凰标准的临床适用性。 方法：我们回顾性分析了171例接受碳离子放疗联合2年雄激素剥夺治疗的高危前列腺癌患者。根据治疗后PSA动力学特征将患者分为三组：无复发组、假性复发组（PSA>2 ng/mL后未经挽救治疗自发下降）和真性复发组（PSA>2 ng/mL后接受挽救治疗）。PSA反弹定义为PSA短暂升高>0.4 ng/mL后自发下降。采用Kaplan-Meier法和受试者工作特征曲线分析评估生化无复发生存率并确定最佳PSA截断值。 结果：171例患者中，18例（10.5%）符合凤凰标准（真性复发+假性复发），其中6例（33.3%）出现PSA自发下降。5年生化无复发生存率为90.0%。33.9%的患者发生PSA反弹。ROC分析确定最佳PSA截断值为1.91 ng/mL（曲线下面积：0.985），而由于PSA反弹的影响，2 ng/mL截断值的阳性预测值仅为61.1%。 结论：碳离子放疗后PSA升高>2 ng/mL并不总是提示高危前列腺癌复发，需谨慎解读以避免过度治疗。

原文链接：

Does PSA Nadir + 2 ng/mL Always Indicate Biochemical Recurrence? A PSA Kinetics-Based Evaluation Following Carbon Ion Radiotherapy for Localized High-Risk Prostate Cancer