文献詳細
特集 ハイリスク前立腺癌を深掘りする―その変遷とM0 CRPCの最新治療
〈局所ハイリスク前立腺癌における課題〉
文献概要
▶ポイント
・局所ハイリスク前立腺癌は前立腺全摘除術に加えアジュバント療法もしくはサルベージ療法などの追加治療が必要となる可能性が高い.
・前立腺全摘除術後pT3,Gleasonスコア8以上,PSA倍加時間3か月未満,生化学的再発までの期間3年未満などのリスク因子を有する症例は予後不良である.
・ハイリスク症例においても前立腺全摘除術後に適切なタイミングで64〜70Gyの十分な放射線療法や内分泌療法を追加することで予後改善が期待できる.
・局所ハイリスク前立腺癌は前立腺全摘除術に加えアジュバント療法もしくはサルベージ療法などの追加治療が必要となる可能性が高い.
・前立腺全摘除術後pT3,Gleasonスコア8以上,PSA倍加時間3か月未満,生化学的再発までの期間3年未満などのリスク因子を有する症例は予後不良である.
・ハイリスク症例においても前立腺全摘除術後に適切なタイミングで64〜70Gyの十分な放射線療法や内分泌療法を追加することで予後改善が期待できる.
参考文献
1) Mottet N, van den Bergh EB, Comford P, et al : Guidelines on Prostate Cancer. EAU guidelines,2019 (https://uroweb.org/guideline/prostate-cancer/)
2) 日本泌尿器科学会(編) : 前立腺癌診療ガイドライン2016年版. メディカルレビュー社, 東京, 2016
3) Yossepowitch O, Eggener SE, Bianco FJ Jr, et al : Radical prostatectomy for clinically localized, high risk prostate cancer : critical analysis of risk assessment methods. J Urol 178 : 493-499 ; discussion 499, 2007
4) Hsu CY, Joniau S, Oyen R, et al : Outcome of surgery for clinical unilateral T3a prostate cancer : a single-institution experience. Eur Urol 51 : 121-128 ; discussion 128-129, 2007
5) Pound CR, Partin AW, Eisenberger MA, et al : Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281 : 1591-1597, 1999
6) Makarov DV, Humphreys EB, Mangold LA, et al : The natural history of men treated with deferred androgen deprivation therapy in whom metastatic prostate cancer developed following radical prostatectomy. J Urol 179 : 156-161, 2008
7) Freedland SJ, Humphreys EB, Mangold LA, et al : Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294 : 433-439, 2005
8) D'Amico AV, Moul JW, Carroll PR, et al : Surrogate end point for prostate cancer specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst 95 : 1376-1383,2003
9) Hernández C, Kim Lee D, Sanchez Pérez M, et al : Accuracy of CAPRA-S Score for Predicting Long-Term Biochemical Progression After Radical Prostatectomy. Clin Genitourin Cancer 17 : e645-649, 2019
10) 日本泌尿器科学会, 日本病理学会, 日本医学放射線学会 (編) : 前立腺癌取扱い規約第4版. 金原出版, 東京, 2010
11) Cox JD, Gallagher MJ, Hammond EH, et al : Consensus statement on radiation therapy of prostate cancer : guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate specific antigen levels after radical prostatectomy : J Clin Oncol 17 : 1155, 1999
12) Ku JY, Lee CH and Ha HK : Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer : Systemic review and meta-analysis of 5-year and 10-year follow-up data. Korean J Urol 56 : 735-741, 2015
13) Gandaglia G, Briganti A, Clarke N, et al : Adjuvant and Salvage Radiotherapy after Radical Prostatectomy in Prostate Cancer Patients. Eur Urol 72 : 689-709, 2017
14) Hwang WL, Tendulkar RD, Niemierko A, et al : Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer with Adverse Pathological Features. JAMA Oncol 4 : e175230, 2018
15) Shipley WU, Seiferheld W, Lukka HR, et al : Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer. N Engl J Med 376 : 417-428, 2017
16) Carrie C, Hasbini A, de Laroche G, et al : Salvage radiotherapy with or without short term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16) : a randomised, multicentre, open-label phase 3 trial. Lancet Oncol 17 : 747-756, 2016
17) Yokomizo A, Satoh T, Hashine K, et al : Randomized controlled trial comparing radiotherapy +/- endocrine therapy versus endocrine therapy alone for PSA failure after radical prostatectomy : Japan Clinical Oncology Group Study JCOG0401. Ann Oncol 28 : mdx370.005, 2017 (https://doi.org/10.1093/annonc/mdx370.005)
18) Ahlgren GM, Flodgren P, Tammela TLJ, et al : Docetaxel Versus Surveillance After Radical Prostatectomy for High-risk Prostate Cancer : Results from the Prospective Randomised, Open-label Phase 3 Scandinavian Prostate Cancer Group 12 Trial. Eur Urol 73 : 870-876, 2018
掲載誌情報