Time to prostate-specific antigen nadir after androgen suppression therapy for postoperative or postradiation PSA failure and risk of prostate dancer-specific mortality
Time to prostate-specific antigen nadir after androgen suppression therapy for postoperative or postradiation PSA failure and risk of prostate dancer-specific mortality
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DOI：
10.1016/j.urology.2007.08.028
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发表时间：
2008-01-01
期刊：
影响因子：
2.1
通讯作者：
D'Amico, Anthony V.
中科院分区：
文献类型：
--
作者：
Chung, Christine S.;Chen, Ming-Hui;D'Amico, Anthony V.
目的 检测前列腺特异性抗原 (PSA) 最低点的时间是否与根治性前列腺切除术或放疗后 PSA 失败的男性中的前列腺癌特异性死亡率 (PCSM) 相关，且在雄激素抑制治疗 (AST) 8 个月后未达到不可检测的 PSA 水平（PSA 水平为 0.2 ng/mL 或更低）。 方法 该队列包括 162 名患有局限性前列腺癌的男性，接受 AST 治疗，以提高根治性前列腺切除术后 PSA 水平前列腺切除术或放射治疗。 Gray 分析用于评估 AST 8 个月后达到 PSA 最低点的时间与进行 PCSM 的时间之间的关联，并调整已确定的预后因素。 AST 8 个月后的中位年龄和随访时间分别为 71.2 岁和 1.8 岁。 结果 调整 Gleason 评分、AST 前 PSA 倍增时间、AST 时的 PSA、PSA 最低值、PSA 失败时间、初始治疗和年龄后，PSA 最低点时间与 PCSM 显着相关（调整后风险比 2.53，95% 置信区间 1.24 至 5.14，P = 0.01）。与 PSA 最低值等于或低于 0.9 ng/mL 的男性相比，PSA 最低值大于中值 0.9 ng/mL 且达到 PSA 最低值的时间长于 4 个月中值的男性的 PCSM 估计值显着更高 (P < 0.001)。结论 达到 PSA 最低值的时间与 PSA 最低值水平相结合，可用于识别短期 AST 疗程后 PCSM 高风险的男性进入使用新型全身药物与 AST 的临床试验。
OBJECTIVES To examine whether the time to the prostate-specific antigen (PSA) nadir was associated with prostate cancer-specific mortality (PCSM) in men with PSA failure after radical prostatectomy or radiotherapy who do not achieve an undetectable PSA level (PSA level of 0.2 ng/mL or less) after 8 months of androgen suppression therapy (AST).METHODS The cohort included 162 men with localized prostate cancer treated with AST for an increasing PSA level after radical prostatectomy or radiotherapy. Gray's analysis was used to evaluate for an association between the time to PSA nadir after 8 months of AST and the time to PCSM, adjusting for established prognostic factors. The median age and follow-up after 8 months of AST was 71.2 and 1.8 years, respectively.RESULTS After adjusting for Gleason score, pre-AST PSA doubling time, PSA at AST, PSA nadir value, time to PSA failure, initial treatment, and age, the time to PSA nadir was significantly associated with PCSM (adjusted hazard ratio 2.53, 95% confidence interval 1.24 to 5.14, P = 0.01). Men with a PSA nadir greater than the median value of 0.9 ng/mL and the time to PSA nadir longer than the median of 4 months had significantly greater PCSM estimates (P < 0.001) compared with men with a PSA nadir of 0.9 ng/mL or less.CONCLUSIONS The time to PSA nadir, combined with the PSA nadir level, can be used to identify men who are at high risk of PCSM after a short course of AST for entry onto clinical trials using novel systemic agents with AST.