Natural history of progression after PSA elevation following radical prostatectomy
Natural history of progression after PSA elevation following radical prostatectomy
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DOI：
10.1001/jama.281.17.1591
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发表时间：
1999-05-05
影响因子：
120.7
通讯作者：
Walsh, PC
中科院分区：
文献类型：
--
作者：
Pound, CR;Partin, AW;Walsh, PC
背景 在接受根治性前列腺切除术后血清前列腺特异性抗原水平 (PSA) 升高的男性中，进展为远处转移和因前列腺癌死亡的自然史尚不清楚。目的 描述根治性前列腺切除术后生化复发男性疾病进展的时间过程。设计对 4 月份之间中位 (SD) 随访 5.3 (3.7) 年（范围，0.5-15 年）的大型手术系列进行回顾性审查1982年和1997年4月，设立城市学术三级转诊机构。患者共有1997名男性因临床局限性前列腺癌由一名外科医生接受根治性前列腺切除术。没有人接受过新辅助治疗，也没有人在记录远处转移之前接受过辅助激素治疗。 主要结果指标 手术后，男性在第一年每 3 个月进行一次 PSA 测定和直肠指检，第二年每半年一次，此后每年一次。可检测到的血清 PSA 水平至少为 0.2 ng/mL 是生化复发的证据。通过放射性核素骨扫描、胸片或其他身体成像来诊断远处转移，这些检查在生化复发时进行，此后每年进行一次。 结果 手术后 15 年，所有 1997 名男性的精算无转移生存率为 82%（95% 置信区间，76%-88%）。 在 1997 名男性中，315 名（15%）出现生化 PSA 水平升高。其中 11 人在复发后接受了早期激素治疗，未纳入本研究。其余 304 名男性中，有 103 名 (34%) 在研究期间出现转移性疾病。从 PSA 水平升高之日起，到转移的平均精算时间为 8 年。在生存分析中，生化进展时间（P
Context In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown.Objective To characterize the time course of disease progression in men with biochemical recurrence after radical prostatectomy.Design A retrospective review of a large surgical series with median (SD) follow-up of 5.3 (3.7) years (range, 0.5-15 years) between April 1982 and April 1997,Setting An urban academic tertiary referral institution.Patients A total of 1997 men undergoing radical prostatectomy, by a single surgeon, for clinically localized prostate cancer. None received neoadjuvant therapy, and none had received adjuvant hormonal therapy prior to documented distant metastases.Main Outcome Measures After surgery, men were followed up with PSA assays and digital rectal examinations every 3 months for the first year, semiannually for the second year, and annually thereafter. A detectable serum PSA level of at least 0.2 ng/mL was evidence of biochemical recurrence. Distant metastases were diagnosed by radionuclide bone scan, chest radiograph, or other body imaging, which was performed at the time of biochemical recurrence and annually thereafter.Results The actuarial metastasis-free survival for all 1997 men was 82% (95% confidence interval, 76%-88%) at 15 years after surgery, Of the 1997 men, 315 (15%) developed biochemical PSA level elevation. Eleven of these underwent early hormone therapy after the recurrence and are not included in the study. Of the remaining 304 men, 103 (34%) developed metastatic disease within the study period. The median actuarial time to metastases was 8 years from the time of PSA level elevation. in survival analysis, time to biochemical progression (P