Background: We evaluated the long-term treatment outcomes of patients with clinically localized and locally advanced prostate cancer (PC) who underwent high-dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT). The primary objective was to identify the optimal timing for discontinuing prostate-specific antigen (PSA) monitoring after HDR-BT. Methods: This analysis included 338 patients with PC who received HDR-BT combined with EBRT between 2006 and 2022 and had a minimum follow-up of 5 years. The patients were stratified based on their PSA levels, and factors associated with recurrence were identified. Results: The median observation period was 8.9 years (range, 5.0–19.0 years). The 10-year recurrence-free survival rate was 92.0%, with 26 recurrences. PSA levels at 5 and 7 years were significantly correlated with oncological outcomes after HDR-BT. Multivariate analysis revealed that a PSA level of >0.2 ng/mL at 5 years was an independent poor prognostic factor for recurrence (hazard ratio, 117.57; 95% confidence interval, 6.22–2223.37;p= 0.001). No patient with a PSA level of ≤0.2 ng/mL at 7 years developed recurrences. Conclusions: Based on our long-term data, we propose that PSA monitoring may be safely discontinued in patients with a PSA level of ≤0.2 ng/mL 7 years after HDR-BT because the risk of recurrence beyond this point is exceedingly low.
背景：本研究评估了接受高剂量率近距离放射治疗（HDR-BT）联合外照射放疗（EBRT）的临床局限性与局部进展性前列腺癌（PC）患者的长期治疗结果，主要目的是确定HDR-BT后停止前列腺特异性抗原（PSA）监测的最佳时机。 方法：本研究纳入2006年至2022年间接受HDR-BT联合EBRT治疗且至少随访5年的338例PC患者。根据PSA水平对患者进行分层，并分析与复发相关的因素。 结果：中位观察期为8.9年（范围5.0–19.0年）。10年无复发生存率为92.0%，共出现26例复发。治疗后5年与7年的PSA水平与HDR-BT后的肿瘤学结局显著相关。多变量分析显示，5年时PSA水平＞0.2 ng/mL是复发的独立不良预后因素（风险比117.57；95%置信区间6.22–2223.37；p=0.001）。7年时PSA水平≤0.2 ng/mL的患者均未出现复发。 结论：基于长期随访数据，我们建议在HDR-BT后7年PSA水平≤0.2 ng/mL的患者可安全停止PSA监测，因为此后复发风险极低。
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