Nasr R, Goldenberg S L
Division of Urology, The Prostate Centre at Vancouver General Hospital, University of British Columbia,Vancouver, B.C, Canada.
Can J Urol. 2001 Aug;8(4):1306-13.
Prostate specific antigen (PSA) has been proven to be a valuable tool in the diagnosis and staging of early prostate cancer and as a sensitive marker of residual or recurrent cancer after curative therapy. In 1998, 200 000 new cases of prostate cancer were reported in the SEER database. Two-thirds of these, or 134 000 men, underwent definitive therapy for localized cancer, including approximately 75 000 radical prostatectomies. It has been reported that 20%-50% of radical prostatectomy patients will have a PSA only recurrence. One can therefore estimate that every year 15 000 to 38 000 men will have a rising PSA following definitive surgical therapy. This elevation of PSA often precedes clinical failure by many years and poses a difficult management problem for which there are not, as yet, definitive management guidelines. This paper will review the definition of PSA recurrence, the natural history, diagnostic options and the therapeutic choices, as illustrated by several genuine cases.
前列腺特异性抗原（PSA）已被证明是早期前列腺癌诊断和分期的重要工具，也是根治性治疗后残留或复发癌的敏感标志物。1998年，监测、流行病学和最终结果（SEER）数据库报告了20万例前列腺癌新病例。其中三分之二，即13.4万名男性，接受了针对局限性癌症的确定性治疗，包括约7.5万例根治性前列腺切除术。据报道，20% - 50%的根治性前列腺切除术患者会出现仅PSA复发的情况。因此可以估计，每年有1.5万至3.8万名男性在确定性手术治疗后PSA会升高。PSA的这种升高通常在临床失败前数年出现，给管理带来了难题，目前尚无明确的管理指南。本文将通过几个真实病例阐述PSA复发的定义、自然病程、诊断选择和治疗选择。
