Roehrborn C G, McConnell J, Bonilla J, Rosenblatt S, Hudson P B, Malek G H, Schellhammer P F, Bruskewitz R, Matsumoto A M, Harrison L H, Fuselier H A, Walsh P, Roy J, Andriole G, Resnick M, Waldstreicher J
University of Texas Southwestern Medical Center at Dallas, USA.
J Urol. 2000 Jan;163(1):13-20.
We analyze patterns of prostate growth in men diagnosed with benign prostatic hyperplasia (BPH) and treated with placebo during 4 years, and determine which baseline parameters were the strongest predictors of growth.
A total of 3,040 men were enrolled in the 4-year randomized, placebo controlled Proscar Long-Term Efficacy and Safety study. Of these men a subgroup of 10% underwent pelvic magnetic resonance imaging prostate volume measurement at baseline and yearly thereafter. Absolute and percent volume changes during 4 years were calculated in the 164 placebo treated men in the subgroup. The ability of age, baseline prostate volume and prostate specific antigen (PSA) to predict prostate growth in placebo treated patients was assessed by multiple linear regression analyses, receiver operator characteristics curves, and evaluations of growth stratified by tertiles of baseline serum PSA and decades of life.
In placebo treated patients a steady increase in mean plus or minus standard deviation prostate volume from year to year was noted (2.5+/-6.1, 4.9+/-6.8, 6.4+/-8.5 and 7.2+/-8.8 ml. at years 1, 2, 3 and 4, respectively). Mean volume changes at 4 years ranged from -9 to +30 ml. Mean percent change from baseline ranged from 12.5% to 16.6% for men 50 to 59 years old to those 70 to 79 years old. Baseline serum PSA was a strong predictor of growth with 7.4% to 22.0% change at 4 years from the lowest to highest PSA tertiles. Annualized growth rates from baseline were 0.7 ml. per year for PSA 0.2 to 1.3, 2.1 for PSA 1.4 to 3.2 and 3.3 for PSA 3.3 to 9.9 ng./ml. Multiple linear regression analysis showed that serum PSA was a stronger predictor of prostate growth than age or baseline prostate volume. All but 1 man with baseline serum PSA greater than 2.0 ng./ml. had prostate growth during 4 years, and 32.6% of men with serum PSA less than 2.0 exhibited a decrease in volume.
Serum PSA is a stronger predictor of growth of the prostate in placebo treated patients than age or baseline prostate volume. Since prostate volume is a risk factor for acute urinary retention and the need for BPH related surgery, the ability of PSA to predict prostate growth may be an important factor when considering individual treatment options for BPH. Such use of PSA represents a shift in paradigm away from focusing solely on symptoms of BPH toward a more comprehensive approach with consideration of predicting and preventing risk factors of BPH related outcomes.
我们分析了诊断为良性前列腺增生（BPH）且在4年中接受安慰剂治疗的男性的前列腺生长模式，并确定哪些基线参数是最强的生长预测指标。
共有3040名男性参与了为期4年的随机、安慰剂对照的保列治长期疗效与安全性研究。其中10%的男性亚组在基线时以及此后每年接受盆腔磁共振成像前列腺体积测量。计算了该亚组中164名接受安慰剂治疗男性在4年中的绝对体积变化和体积百分比变化。通过多元线性回归分析、受试者工作特征曲线以及按基线血清PSA三分位数和年龄十年分层的生长评估，评估年龄、基线前列腺体积和前列腺特异性抗原（PSA）预测安慰剂治疗患者前列腺生长的能力。
在接受安慰剂治疗的患者中，每年观察到平均加减标准差前列腺体积稳步增加（第1、2、3和4年分别为2.5±6.1、4.9±6.8、6.4±8.5和7.2±8.8 ml）。4年时的平均体积变化范围为-9至+30 ml。50至59岁男性至70至79岁男性从基线的平均百分比变化范围为12.5%至16.6%。基线血清PSA是生长的有力预测指标，从最低至最高PSA三分位数在4年时有7.4%至22.0%的变化。从基线开始的年化增长率对于PSA 为0.2至1.3 ng/ml的患者为每年0.7 ml，对于PSA 为1.4至3.2 ng/ml的患者为2.1 ml，对于PSA 为3.3至9.9 ng/ml的患者为3.3 ml。多元线性回归分析表明，血清PSA比年龄或基线前列腺体积更能预测前列腺生长。除1名基线血清PSA大于2.0 ng/ml的男性外，所有男性在4年中都有前列腺生长，而血清PSA小于2.0的男性中有32.6%体积减小。
在接受安慰剂治疗的患者中，血清PSA比年龄或基线前列腺体积更能预测前列腺生长。由于前列腺体积是急性尿潴留和BPH相关手术需求的危险因素之一，PSA预测前列腺生长的能力在考虑BPH个体治疗方案时可能是一个重要因素。这种对PSA的应用代表了一种范式转变，从仅关注BPH症状转向更全面的方法，即考虑预测和预防BPH相关结局的危险因素。
