Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: Prostate specific antigen cure rates appear constant between 2 and 9 ng./ml.
Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: Prostate specific antigen cure rates appear constant between 2 and 9 ng./ml.
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DOI：
10.1016/s0022-5347(05)65392-x
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发表时间：
2002-01-01
影响因子：
6.6
通讯作者：
Yemoto, CM
中科院分区：
文献类型：
--
作者：
Stamey, TA;Johnstone, IM;Yemoto, CM
目的：血清前列腺特异性抗原(PSA)被广泛用于指导前列腺癌的活检和对50岁以上男性前列腺癌和非前列腺癌患者的跟踪检查。然而，良性前列腺增生症(BPH)是血清PSA值在2到10 ng/ml之间的常见原因。更好地了解血清PSA与前列腺癌和BPH之间的关系是很重要的。材料和方法：从1984年12月到1997年1月，共有875例男性患者接受了前列腺癌根治术。在这些男性中，784人的血清PSA水平在2到22毫微克/毫升之间，其中579人的最大癌症位于前列腺周围地带。在579名男性中，有406人在根治性前列腺切除术后血清PSA随访超过3年。我们检验了784名男性患者术前血清PSA与Gleason 4/5级和3-1级癌体积之间的皮尔逊相关性(R-2)，将周围区和移行区癌分开。我们采用折线回归的方法，在579例男性外周带癌患者中，分别以7和9 ng/mlPSA的折线折线回归来总结每种PSA倍增与5种不同形态变量的关系。断点为9纳克/毫升，用于测量前列腺重量。将6个形态变量与PSA之间的局部回归关系的趋势摘要叠加在PSA<22 ng/ml的579名男性的全散点图上。使用Cox比例风险模型检验了406名PSA最少随访3年以上的男性5年无PSA失败的概率。结果：875名男性的肿瘤体积与术前血清PSA之间的皮尔逊相关性很弱(r(2)=0.27)，而且是由血清PSA>22 ng/ml的大型癌症驱动的。周边区癌641例男性低级别和高级别癌症的总体R-2 x 100为10%，而低级别癌症仅为3%，也就是说，这些外周区域癌症产生的PSA几乎没有进入血清。所有的形态变量在低于7至9 ng/ml的PSA的医学意义下的变化速率是可疑的，但在高于9 ng/ml的速率下，这些关系的R-2从未大于15%。PSA在所有水平上的个体形态差异都很大，强调了PSA作为前列腺癌形态预测指标的严重局限性。PSA每倍增<9 ng/ml，前列腺重量增加21%，高于9 ng/ml，仅增加4.8%。结论：术前血清PSA与前列腺癌体积和分级无临床相关性，而与PSA治愈率关系有限，PSA水平在2~9 ng/ml之间。
Purpose: Serum prostate specific antigen (PSA) is widely used as a guide to initiate prostatic biopsies and to follow men older than 50 years old with and without prostate cancer. However benign prostatic hyperplasia (BPH) is a common cause of serum PSA values between 2 and 10 ng./ml. A better understanding of the relationships among serum PSA, prostate cancer and BPH is important.Materials and Methods: A total of 875 men underwent radical prostatectomy at our institution between December 1984 and January 1997. Of these men 784 had a serum PSA of 2 to 22 ng./ml., including 579 with the largest cancer located in the peripheral zone of the prostate. Of the 579 men 406 had serum PSA followups for greater than 3 years after radical prostatectomy. We examined Pearson correlations (R-2) between preoperative serum PSA, and the volume of Gleason grades 4/5 and 3 to 1 cancer in 784 men, separating peripheral zone from transition zone cancers. We used broken line regression with break points of 7 and 9 ng./ml. preoperative PSA to summarize the relationship of each PSA doubling to 5 different morphological variables in 579 men with peripheral zone cancer. A 9 ng./ml. break point was used for prostate weight. Trend summaries with a local regression line for the relationships between 6 morphological variables and PSA were superimposed on full scatterplots of the 579 men with PSA less than 22 ng./ml. Cox proportional hazard models were used to examine 5-year PSA failure-free probabilities based on 406 men with minimal PSA followups greater than 3 years at break points of 7 to 9 ng./ml. PSA.Results: Pearson correlation between cancer volume and preoperative serum PSA in 875 men was weak (r(2) = 0.27) and driven by large cancers with serum PSA greater than 22 ng./ml. For peripheral zone cancer the overall R-2 x 100 for 641 men with low and high grade cancer was 10% and only 3% for low grade cancer, that is almost no PSA produced by these peripheral zone cancers enters the serum. All morphological variables changed at rates of doubtful medical significance below a PSA of 7 to 9 ng./ml. but at rates that were significantly worse above 9 ng./ml. R-2 for these relationships was never greater than 15%. Large individual morphological variations at all levels of PSA emphasize the serious limitation of PSA as a predictor of prostate cancer morphology. Below 9 ng./ml. prostate weight increased by 21% for each doubling of PSA but above 9 ng./ml. the increase was only 4.8%.Conclusions: Preoperative serum PSA has a clinically useless relationship with cancer volume and grade in radical prostatectomy specimens, and a limited relationship with PSA cure rates at preoperative serum PSA levels of 2 to 9 ng./ml. Trend summaries for prostate weight on broken line regression showed that below 9 ng./ml. BPH is a strong contender for the cause of PSA elevation, constituting the primary cause of the over diagnosis of prostate cancer.