Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era
Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era
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DOI：
10.1016/s0360-3016(02)02940-1
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发表时间：
2002-10-01
影响因子：
7
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：评价前列腺癌根治术(RP)和体外放射治疗(EBRT)后前列腺特异性抗原(PSA)结果的变化，并对PSA治疗期间的随访进行控制。方法与材料：从1989年至2000年，1440例临床局限性前列腺癌患者接受了RP(n=1059)或EBRT(n=381)治疗。一位泌尿生殖病理学家检查了所有的病理标本。对于有两年最短随访的患者，计算三个时期(1989年1月1日至1992年12月31日；1993年1月1日至1996年12月31日；1997年1月1日至2000年12月31日)按风险组(低风险组与高风险组)分层的两年实际PSA结果，并对每种治疗方式进行比较。结果：在研究期间，接受放射治疗和放疗的患者低风险疾病的比例显著增加(p<；0.0001)，分别从60%增加到89%，从26%增加到76%。此外，两年的实际PSA结果也从60%提高到82%(RP：P<；0.0001)和从67%提高到91%(RT：P=0.0008)。低风险患者的2年实际PSA结果没有显著差异，但在接受RP(从20%到39%到75%，p=0.0004)或放疗(从50%到59%到83%，p=0.0004)的高危患者中，两年的实际PSA结果有所改善。前列腺特异性抗原结果的这种改善可以通过向更有利的前列腺特异性抗原水平(rp：P=0.0002；rt：p=0.006)和临床T分期(rp：p=0.0008，rt：p<；0.0001)的转变来解释。结论：在≥7疾病活检术后的pSA时代，pSA结果的改善是由于临床表现转向低风险疾病和更早发现高级别疾病。©2002 Elsevier Science Inc.
Purpose: To evaluate the change in prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) or external beam radiotherapy (EBRT), controlling for follow-up during the PSA era.Methods and Materials: The study cohort consisted of 1440 patients with clinically localized prostate cancer managed with RP (n = 1059) or EBRT (n = 381) between 1989 and 2000. A single genitourinary pathologist reviewed all pathology specimens. For patients with a 2-year minimal follow-up, the 2-year actual PSA outcome stratified by risk group (low vs. high) was calculated for three periods (January 1, 1989 to December 31, 1992; January 1, 1993 to December 31, 1996; and January 1, 1997 to December 31, 2000) and compared for each treatment modality. PSA failure was defined using the American Society for Therapeutic Radiology and Oncology consensus definition for all patients, and comparisons were made using a chi-square metric.Results: During the study period, the proportion of patients treated with RP and EBRT with low-risk disease increased significantly (p < 0.0001) from 60% to 89% and from 26% to 76%, respectively. In addition, the 2-year actual PSA outcome also improved from 60% to 82% (RP: p < 0.0001) and from 67% to 91% (RT: p = 0.0008). The 2-year actual PSA outcome was not significantly different in the low-risk patients but improved during the three periods in the high-risk patients treated with RP (from 20% to 39% to 75%, p = 0.0004) or EBRT (from 50% to 59% to 83%, p = 0.01). This improvement in PSA outcome could be explained by a shift toward a more favorable PSA level (RP: p = 0.0002; RT: p = 0.006) and clinical T stage (RP: p = 0.0008, RT: p < 0.0001) distribution for patients with biopsy Gleason score ≥7 disease.Conclusion: Improved PSA outcome during the PSA era after RP or EBRT has resulted from a shift in presentation toward low-risk disease and earlier detection of high-grade disease. © 2002 Elsevier Science Inc.