Prostate specific antigen versus prostate specific antigen density as a prognosticator of pathological characteristics and biochemical recurrence following radical prostatectomy
Prostate specific antigen versus prostate specific antigen density as a prognosticator of pathological characteristics and biochemical recurrence following radical prostatectomy
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DOI：
10.1016/j.juro.2008.01.032
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发表时间：
2008-05-01
影响因子：
6.6
通讯作者：
Gonzalgo, Mark L.
中科院分区：
文献类型：
--
作者：
Magheli, Ahmed;Rais-Bahrami, Soroush;Gonzalgo, Mark L.
目的：前列腺特异性抗原密度对于预测根治性前列腺切除术后病理分期和生化复发的有用性还没有很好的定义。我们研究了前列腺特异性抗原密度是否比总前列腺特异性抗原在预测根治性前列腺切除术后不良病理特征和疾病复发方面具有优势。材料和方法：1984年至2006年间，共有13，434名因临床局限性前列腺癌接受根治性前列腺切除术的男性被纳入本研究。根据Gleason评分（6分或更低、7分和8分或更高）对研究人群进行分层，并比较各组的临床和病理特征。我们构建了ROC曲线，并确定了ROC AUC和一致性指数，以专门研究前列腺特异性抗原和前列腺特异性抗原密度预测病理分期和生化复发的准确性。前列腺特异性抗原密度比前列腺特异性抗原更能预测活检Gleason评分为6分或更低的患者的前列腺外扩展和无生化复发（每种p < 0.001）。在活检患者中，前列腺特异性抗原Gleason评分为7比前列腺特异性抗原密度更能预测精囊受累（p < 0.001）、淋巴结受累（p = 0.017）和无生化复发（p < 0.001）。前列腺特异性抗原和前列腺特异性抗原密度在病理或临床outcomes.Conclusions的预后价值方面没有统计学差异的男性活检Gleason评分为8或更高：前列腺特异性抗原密度是高度相关的病理分期和生化无生存根治性前列腺癌切除术。在低级别前列腺癌中，与总前列腺特异性抗原相比，前列腺特异性抗原密度在预测前列腺外扩展和无生化复发方面显着更准确。在对患者进行根治性乳房切除术后的结局咨询时，应考虑到这一点。
Purpose: The usefulness of prostate specific antigen density for predicting pathological stage and biochemical recurrence after radical prostatectomy has not been well defined. We investigated whether prostate specific antigen density yielded an advantage over total prostate specific antigen for predicting adverse pathological characteristics and disease recurrence following radical prostatectomy.Materials and Methods: A total of 13,434 men who underwent radical prostatectomy for clinically localized prostate cancer between 1984 and 2006 were included in this study. The study population was stratified by Gleason score (6 or less, 7, and 8 or greater), and the clinical and pathological characteristics of each group were compared. We constructed ROC curves and determined the ROC AUC and concordance index to specifically investigate the accuracy of prostate specific antigen and prostate specific antigen density for predicting pathological stage and biochemical recurrence.Results: Prostate specific antigen density was better than prostate specific antigen for predicting extraprostatic extension and biochemical-free recurrence in patients with a biopsy Gleason score of 6 or less (each p < 0.001). In patients with a biopsy Gleason score of 7 prostate specific antigen was more predictive than prostate specific antigen density for seminal vesicle involvement (p < 0.001), lymph node involvement (p = 0.017) and biochemical-free recurrence (p < 0.001). In men with a biopsy Gleason score of 8 or greater there was no statistical difference between prostate specific antigen and prostate specific antigen density in terms of prognostic value for pathological or clinical outcomes.Conclusions: Prostate specific antigen density is highly associated with pathological stage and biochemical-free survival following radical prostatectomy. In lower grade prostate cancers prostate specific antigen density is significantly more accurate for predicting extraprostatic extension and biochemical-free recurrence compared to total prostate specific antigen. It should be considered when counseling patients on outcomes following radical prostatectomy.