Benaim Elie A, Pace Christopher M, Lam Po M, Roehrborn Claus G
Department of Urology, University of Texas Southwestern Medical Center at Dallas and North Texas Veterans Affairs Health Care Center, Dallas, Texas 75390-9110, USA.
Urology. 2002 Jan;59(1):73-8. doi: 10.1016/s0090-4295(01)01440-6.
To determine the value of the before and after treatment level of prostate-specific antigen (PSA) to predict the time to androgen-independent progression (AIP) in patients with advanced prostate cancer who received androgen-deprivation therapy (ADT) at the time of recurrence or progression.
The records of 153 patients with advanced or metastatic prostate cancer who were treated with ADT were retrospectively reviewed. Fifty-six percent of the patients were initially treated with ADT. In the remainder, ADT was started at progression and/or failure. AIP was defined as two consecutive elevations of serum PSA above the nadir value by any threshold. Kaplan-Meier and multiple logistic regression analyses were used to determine the potential predictors of AIP.
The median duration of the PSA response was 24 months. The most important predictors of the time to AIP were the initial Gleason grade and the nadir PSA level after the initiation of ADT. The odds ratio of having a response greater than 24 months was 15-times higher in patients achieving an undetectable serum PSA level versus those who did not. For each point increase in the Gleason sum, patients had a five times higher chance of progressing to AIP in 24 months or less.
The ability to achieve an undetectable nadir PSA level and the initial Gleason grade are significant predictors of the time to AIP in men treated with ADT for metastatic and advanced prostate cancer.
确定在复发或进展时接受雄激素剥夺治疗（ADT）的晚期前列腺癌患者中，治疗前后前列腺特异性抗原（PSA）水平对于预测雄激素非依赖性进展（AIP）时间的价值。
回顾性分析153例接受ADT治疗的晚期或转移性前列腺癌患者的记录。56%的患者最初接受ADT治疗。其余患者在疾病进展和/或治疗失败时开始ADT治疗。AIP定义为血清PSA连续两次升高超过最低点值，升高幅度不限。采用Kaplan-Meier法和多因素logistic回归分析确定AIP的潜在预测因素。
PSA反应的中位持续时间为24个月。AIP时间的最重要预测因素是初始Gleason分级和ADT开始后的最低点PSA水平。血清PSA水平不可检测的患者出现反应超过24个月的比值比是未达到此水平患者的15倍。Gleason总分每增加1分，患者在24个月或更短时间内进展为AIP的可能性增加5倍。
对于接受ADT治疗的转移性和晚期前列腺癌男性患者，达到不可检测的最低点PSA水平的能力和初始Gleason分级是AIP时间的重要预测因素。
