前立腺全摘術後のPSA再発に対する放射線治療の検討

Abstract

前立腺全摘術後のPSA再発に対する放射線治療について検討した.対象は, 前立腺全摘術後PSA再発で局所へ放射線治療を施行した8例(平均年齢65.4歳)で, 手術後平均観察期間は1169.1日であった.手術後PSA再発までの平均期間は442.1日, 手術から照射開始までの平均期間は705.4日, PSA倍加時間は2例が3ヵ月未満, 6例が6ヵ月以上であった.放射線治療開始時のPSA値は0.31～1.9ng/mlで, 8例中7例でPSA値の低下を認め, 1例はPSA値の上昇で治療を中止した.放射線治療後の経過は, PSA値が低下した7例では現在までPSAの再上昇はなく, 7例中4例はPSA nadirに達し, その値は0.01～0.28ng/mlであった.合併症は早期に下痢1例, 肛門痛1例を認めたが放射線治療終了後は消失し, 晩期合併症は現在まで認めていない.以上, 術後PSA再発への3次元原体照射法による放射線治療は有用な治療法と考えられた

We studied the effect of radiotherapy on patients with re-elevation of prostate specific antigen (PSA) after radical prostatectomy. Radiotherapy was performed on 8 patients with re-elevated PSA after radical prostatectomy without any previous treatment. Pathological stages were B in 2 patients, and C in 6 patients. Patients received three-dimensional dynamic conformal radiotherapy, and irradiation doses ranged from 44 to 70 Gy (median 60). The target area of irradiation included prostatic bed and seminal vesicles. PSA levels before radiotherapy were 0.31-1.9 ng/ml (median 0.40). In 7 patients, PSA levels decreased and no increase has been observed thereafter. In one patient, PSA level increased during radiotherapy; therefore, the treatment was discontinued at 44 Gy. Two patients suffered grade 1 to 2 acute toxicities, and no late toxicity has been observed so far. Radiotherapy is considered one of the effective treatments for re-elevation of PSA after radical prostatectomy.