THE CLINICAL USEFULNESS OF SERUM PROSTATE SPECIFIC ANTIGEN AFTER HORMONAL-THERAPY OF METASTATIC PROSTATE-CANCER
THE CLINICAL USEFULNESS OF SERUM PROSTATE SPECIFIC ANTIGEN AFTER HORMONAL-THERAPY OF METASTATIC PROSTATE-CANCER
复制标题
DOI：
10.1016/s0022-5347(17)37432-3
复制
发表时间：
1992-03-01
影响因子：
6.6
通讯作者：
BOTTACCINI, MR
中科院分区：
文献类型：
--
作者：
MILLER, JI;AHMANN, FR;BOTTACCINI, MR
我们纵向跟踪了 48 名接受睾丸切除术、每月黄体生成素释放激素注射或持续己烯雌酚治疗 D2 期前列腺癌患者的血清前列腺特异性抗原 (PSA) 水平，并取得了客观缓解。其中 34 名患者有疾病进展的临床证据（中位缓解持续时间 19 个月）。 14 名仍处于缓解状态的患者的中位随访时间为 42 个月。治疗前的表现状态、治疗前通过骨扫描测量的转移范围和治疗后最低 PSA 水平与缓解持续时间单变量相关。调整前 2 个预处理变量后，最低 PSA 水平对缓解持续时间的高度显着的独立影响持续存在。治疗后 PSA 水平最低点降至 4 ng./ml 以下的患者。与最低 PSA 保持升高的患者相比，缓解持续时间显着更长（中位 42 个月与 10 个月，p < 0.0001）。没有观察到任何病例出现进展（根据我们的独立于 PSA 水平的标准定义），而连续治疗后 PSA 水平在达到最低点后继续下降或保持在平台状态。对于所有患者来说，一旦达到最低点，PSA 开始增加的时间早于进展的客观证据，除了 2 名患者同时发生这 2 个事件（平均前置时间 7.3 +/- 5.0 个月）。我们得出的结论是，对接受雄激素消融治疗的转移性前列腺癌患者进行连续 PSA 水平监测，有助于在治疗过程早期区分有利反应者和不利反应者，并极大有助于监测进展。
We longitudinally followed serum prostate specific antigen (PSA) levels in 48 patients who were treated with either orchiectomy, monthly luteinizing hormone-releasing hormone injection or continuous diethylstilbestrol for stage D2 prostate adenocarcinoma and achieved an objective response. Of the patients 34 had clinical evidence of disease progression (median remission duration 19 months). Median length of followup for the 14 patients who remained in remission was 42 months. Pretreatment performance status, pretreatment extent of metastases as measured by a bone scan and post-treatment nadir PSA level were univariately correlated with remission duration. After adjustment for the 2 former pretreatment variables, a highly significant independent effect of the nadir PSA level on remission duration persisted. Patients whose post-treatment nadir PSA level decreased below 4 ng./ml. had a significantly longer remission duration than those whose nadir PSA remained elevated (median 42 versus 10 months, p < 0.0001).No cases were observed to progress (as defined by our criteria independent of PSA level) while the serial post-treatment PSA levels continued to decrease or remained at a plateau after reaching the nadir. The time at which the PSA began to increase once the nadir was reached predated objective evidence of progression in all patients except 2 in whom the 2 events occurred simultaneously (mean lead time 7.3 +/- 5.0 months). We conclude that following serial PSA levels in patients treated with androgen ablation for metastatic prostate cancer can aid in distinguishing favorable from nonfavorable responders early in the course of therapy and greatly assist in monitoring for progression.