Kawa Gen, Hiura Yoshihito, Satoh Hisashi, Sugi Motohiko, Fujita Ichiro, Oguchi Naoki, Doi Hiroshi, Ashida Makoto, Okada Hiyoshi, Muguruma Koei, Murota Takashi, Koyama Yasuki, Kawamura Hiroshi, Ohara Takashi, Kawakita Mutsushi, Matsuda Tadashi
Kansai Medical University, Prostate Study Group.
Hinyokika Kiyo. 2002 Mar;48(3):133-8.
To search for a more suitable qualification indicating watchful waiting, we performed a retrospective study against early-stage prostate cancer patients managed without initial treatment. Thirty-three patients who had not been treated for more than 6 months after diagnosed as T1c or T2 prostate cancer were studied. The median values of total observation period, age at diagnosis, and initial PSA were 27.0 months, 69.0 years old, and 7.0 ng/ml, respectively. Among 28 patients who had had measurement of serum PSA at least three times, seven patients showed a significant PSA elevation when transition of PSA level was analyzed using linear regression analysis. The other patients had been stable or PSA level declined. Between these two groups, there was no significant difference regarding age, initial PSA, PSA density, Gleason score, number of cancer-positive core, and cancer-occupying rate in biopsy specimen. The median PSA doubling time in patients showing PSA elevation was 36.3 months. There were no patients showing PSA elevation among those with a cancer-occupying rate of less than 5%. Clinical disease progression was obviously observed in two cases although one did not show PSA elevation. During the observation period, treatment was eventually started in seven patients. The 5-year rate of no treatment was 53.8%. Although a significant independent factor predicting the future treatment was not identified, univariate analysis revealed that the initial PSA value in patients undergoing treatment was significantly higher than that of those without treatment (p = 0.032). We concluded that early-stage prostate cancer has clinical variability, and regular clinical evaluations as digital rectal examination should be performed when the patient was managed with watchful waiting.
为了寻找一个更合适的表示观察等待的指标，我们对未经初始治疗的早期前列腺癌患者进行了一项回顾性研究。研究对象为33例被诊断为T1c或T2期前列腺癌且在诊断后6个月以上未接受治疗的患者。总观察期、诊断时年龄及初始前列腺特异抗原（PSA）的中位数分别为27.0个月、69.0岁和7.0 ng/ml。在28例至少进行过3次血清PSA检测的患者中，使用线性回归分析PSA水平变化时，7例患者PSA显著升高。其他患者PSA水平稳定或下降。两组在年龄、初始PSA、PSA密度、Gleason评分、癌阳性穿刺针数及活检标本中癌组织占有率方面无显著差异。PSA升高患者的PSA倍增时间中位数为36.3个月。癌组织占有率低于5%的患者中无PSA升高者。尽管有1例患者未出现PSA升高，但仍有2例明显观察到临床疾病进展。在观察期内，最终有7例患者开始接受治疗。5年未治疗率为53.8%。虽然未确定预测未来治疗的显著独立因素，但单因素分析显示，接受治疗患者的初始PSA值显著高于未接受治疗者（p = 0.032）。我们得出结论，早期前列腺癌具有临床变异性，当对患者进行观察等待管理时，应定期进行如直肠指检等临床评估。
