Nakata S, Takahashi H, Takezawa Y, Kobayashi M, Matumoto K, Kosaku N, Kawashima K
Department of Urology, Ashikaga Red Cross Hospital.
Nihon Hinyokika Gakkai Zasshi. 2000 Jul-Aug;91(7-8):584-8. doi: 10.5980/jpnjurol1989.91.584.
The PSA level of prostate cancer patients generally declines after endocrine therapy, but elevates when the cancer relapses in most cases. However, the rate of elevation differs with the case. We investigated the PSA doubling time (PSA-DT) of the prostate cancer patients whose PSA declined after endocrine therapy and later re-elevated, and investigated the relationship with other parameters.
We investigated 55 prostate cancer patients who underwent endocrine therapy between 1991 and 1998. Their PSA re-elevated continuously after their PSA fell below 10 ng/ml after the endocrine therapy as the first line treatment. First, the correlation coefficients with time and PSA were calculated in order to decide whether their PSA elevation was exponential or linear. PSA-DT was calculated thereafter, and compared with the clinical stage, pathological differentiation, clinical relapse style, time from the beginning of the therapy to PSA relapse, pre-treatment PSA value, and prognosis. The relationship between PSA-DT and each clinical parameter was tested using the Kruskal-Wallis test. Differences in survival rates and PSA-DT were calculated using the log-rank test.
PSA elevated exponentially after cancer relapsed. PSA-DT in all cases ranged from 0.5 to 26.3 months, with an average of 4.4 +/- 4.8 (S.D.) months and the median was 2.5 months. PSA-DT was significantly (p < 0.01) short when the pre-treatment clinical stage was high, the time from the beginning of the therapy to PSA relapse was short, or the pre-treatment PSA value was high. PSA-DT tended to be short when the pre-treatment pathological differentiation was low, but not significantly. PSA-DT tended to be short when the cancer relapsed as distant metastasis rather than regional relapse, but not significantly. Prognosis from the initial treatment and PSA relapse was significantly poor when the PSA-DT was short.
PSA elevated exponentially in the relapsed prostate cancer patients after the endocrine therapy. PSA-DT was distributed in a very wide range, and this value was considered to reflect the malignant potential and prognosis of the cancer. PSA-DT may be useful for determining the strategy after relapse.
前列腺癌患者接受内分泌治疗后，其前列腺特异性抗原（PSA）水平通常会下降，但在大多数情况下，癌症复发时该水平会升高。然而，升高的速率因病例而异。我们研究了内分泌治疗后PSA下降随后又再次升高的前列腺癌患者的PSA倍增时间（PSA-DT），并研究了其与其他参数的关系。
我们研究了1991年至1998年间接受内分泌治疗的55例前列腺癌患者。作为一线治疗，在内分泌治疗后其PSA降至10 ng/ml以下后，PSA持续再次升高。首先，计算与时间和PSA的相关系数，以确定其PSA升高是呈指数型还是线性。此后计算PSA-DT，并与临床分期、病理分化、临床复发方式、从治疗开始至PSA复发的时间、治疗前PSA值及预后进行比较。使用Kruskal-Wallis检验来检测PSA-DT与各临床参数之间的关系。使用对数秩检验计算生存率和PSA-DT的差异。
癌症复发后PSA呈指数升高。所有病例的PSA-DT范围为0.5至26.3个月，平均为4.4±4.8（标准差）个月，中位数为2.5个月。当治疗前临床分期高、从治疗开始至PSA复发的时间短或治疗前PSA值高时，PSA-DT显著缩短（p<0.01）。当治疗前病理分化低时，PSA-DT往往较短，但无显著差异。当癌症以远处转移而非局部复发形式复发时，PSA-DT往往较短，但无显著差异。当PSA-DT短时，初始治疗及PSA复发后的预后显著较差。
内分泌治疗后复发的前列腺癌患者PSA呈指数升高。PSA-DT分布范围非常广泛，该值被认为反映了癌症的恶性潜能和预后。PSA-DT可能有助于确定复发后的治疗策略。
