Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database.
Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database.
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DOI：
10.1016/j.eururo.2012.11.052
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发表时间：
2014-03
期刊：
影响因子：
23.4
通讯作者：
Freedland, Stephen J.
中科院分区：
文献类型：
--
作者：
Keto, Christopher J.;Aronson, William J.;Terris, Martha K.;Presti, Joseph C.;Kane, Christopher J.;Amling, Christopher L.;Freedland, Stephen J.
在雄激素剥夺治疗(ADT)中，前列腺特异性抗原(PSA)水平&0.2 ng/ml与较好的结果相关。然而，并不是所有的男性都在8个月内达到最低的PSA水平。ADT上最低的PSA--具体地说是0.2 ng/ml--是否可以用于风险分层还没有测试。我们研究了前列腺癌根治术(RP)后早期接受ADT治疗的男性患者中，小但可检测的PSA最低值对前列腺癌(PCA)特异性预后的预测价值。我们从搜索数据库中对转移前行RP术后ADT治疗的男性进行了回顾性回顾。我们确定了402名接受ADT治疗的男性在RP后PSA升高，其中294名男性有完整的数据。PSA最低点后的中位随访时间为49个月。所有男性的PSA最低值为4 ng/ml；223名男性(76%)的PSA最低值未被检测到。无放射学证据的RP术后PSA升高的ADT。ADT的PSA最低值定义为ADT期间的最低PSA值。比例风险模型和C指数分别用来检验PSA最低值和PCa特异性结果之间的关联性和预测准确性。PSA值在0.01%到0.2ngml之间的男性比未检测到低值的男性有更大的风险进展为去势抵抗型前列腺癌(风险比：5.14；p<；0.001)、转移(风险比：3.98；p=0.006)和前列腺癌特异性死亡率(风险比：5.33；p=0.003)。当数据仅限于男性且PSA超敏(灵敏度为0.01 ng/ml)时，PSA最低值单独预测CRPC、转移和PCSM的C指数分别为0.88、0.91和0.96。PSA在ADT上的最低值，即使在非常低的水平，也能强烈地预测进展为CRPC、转移和PCSM。在ADT期间可检测到PSA最低值的男性应考虑进行临床试验。
A prostate-specific antigen (PSA) level <0.2 ng/ml on androgen-deprivation therapy (ADT) is correlated with better outcomes. However, not all men reach a nadir PSA level within 8 mo. Whether the lowest PSA on ADT—specifically, <0.2 ng/ml—can be used for risk stratification is untested. We examined the predictive value of small but detectable PSA nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA nadir was 49 mo. All men had a PSA nadir <4 ng/ml; 223 men (76%) had an undetectable nadir. ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. PSA nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA nadir and PCa-specific outcomes. Men with a PSA nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p < 0.001), metastases (HR: 3.98; p = 0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p = 0.003) than men with an undetectable nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. A PSA nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA nadir during ADT should be considered for clinical trials.
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影响因子：
23.4
作者：
Pagliarulo, Vincenzo;Bracarda, Sergio;Eisenberger, Mario A.;Mottet, Nicolas;Schroeder, Fritz H.;Sternberg, Cora N.;Studer, Urs E.
通讯作者：
Studer, Urs E.
影响因子：
4.8
作者：
Banez, L. L.;Loftis, R. M.;Freedland, S. J.;Presti, J. C., Jr.;Aronson, W. J.;Amling, C. L.;Kane, C. J.;Terris, M. K.
通讯作者：
Terris, M. K.
影响因子：
6.6
作者：
MILLER, JI;AHMANN, FR;BOTTACCINI, MR
通讯作者：
BOTTACCINI, MR
影响因子：
6.6
作者：
Morote, Juan;Orsola, Anna;Catalan, Roberto
通讯作者：
Catalan, Roberto
影响因子：
23.4
作者：
Tombal, Bertrand;Miller, Kurt;Persson, Bo-Eric
通讯作者：
Persson, Bo-Eric