Lower prostate specific antigen outcome than expected following radical prostatectomy in patients with high grade prostate cancer and a prostatic specific antigen level of 4 ng./ml. or less
Lower prostate specific antigen outcome than expected following radical prostatectomy in patients with high grade prostate cancer and a prostatic specific antigen level of 4 ng./ml. or less
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DOI：
10.1016/s0022-5347(05)65076-8
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发表时间：
2002-05-01
影响因子：
6.6
通讯作者：
Richie, JP
中科院分区：
文献类型：
--
作者：
D'Amico, AV;Chen, MH;Richie, JP
目的：我们根据前列腺特异性抗原(PSA)水平来评估前列腺癌根治术后10年的预后。材料和方法：1989年至2001年，2,254例临床局限性前列腺癌患者接受根治性前列腺癌根治术。采用Kaplan和Meier的精算方法评估PSA结果，并根据PSA值和针刺活检及前列腺摘除Gleason评分进行分层。结果：随着PSA值的升高，PSAGleason评分小于或等于6分的患者的10年PSA值显著下降(p<0.002)。Gleason评分在7分或更高的活检和前列腺切除术中观察到了这一趋势，但PSA 4或更低的组与PSA>4到10 ng/ml的组相比，表现明显更差(46%比62%，p=0.03)。这一发现可能是由于血清游离睾酮水平较低以及前列腺癌患者Gleason评分在8-10分之间的比例显著增加(25%对16%，p=0.03)，而在PSA4分或以下组中高于4-10 ng/ml组。结论：根治性前列腺癌标本中Gleason分级为4或5级且PSA值在4 ng/ml或以下的患者可能是雄激素缺乏，与目前的PSA水平相比，对10年PSA结果的估计明显更低。
Purpose: We report the estimates of 10-year prostate specific antigen (PSA) outcome following radical prostatectomy in patients with or without grade 4 or 5 disease in the needle biopsy or prostatectomy specimen stratified by the presenting PSA level.Materials and Methods: From 1989 to 2001, 2,254 patients treated with radical prostatectomy for clinically localized prostate cancer comprised the study cohort. PSA outcome was estimated using the actuarial method of Kaplan and Meier, and was stratified by the presenting PSA level and needle biopsy and prostatectomy Gleason score.Results: The 10-year estimates of PSA outcome declined significantly (p less than or equal to 0.002) for patients with biopsy or prostatectomy Gleason score 6 or less as the presenting PSA level increased. This trend was observed for biopsy and prostatectomy Gleason score 7 or higher except for the PSA 4 or less group which did significantly worse (46% versus 62%, p = 0.03) compared to the PSA greater than 4 to 10 ng./ml. group. This finding may be explained by a low serum free testosterone level and the presence of a significantly higher proportion of prostatectomy Gleason score 8 to 10 disease (25% versus 16%, p = 0.03) in the PSA 4 or less versus greater than 4 to 10 ng./ml. group.Conclusions: Patients with Gleason grade 4 or 5 disease in the radical prostatectomy specimen and a presenting PSA of 4 ng./ml. or less may be androgen deficient and have a significantly lower estimate of 10-year PSA outcome then expected based on the presenting PSA level.