Dattoli Michael, Wallner Kent, True Lawrence, Cash Jennifer, Sorace Richard
Dattoli Cancer Center and Brachytherapy Research Institute, Sarasota, Florida 34237, USA.
Cancer. 2003 Feb 15;97(4):979-83. doi: 10.1002/cncr.11154.
The objective of this study was to define the long-term prognostic significance of prostatic acid phosphatase (PAP) levels in patients with higher risk, early-stage prostate carcinoma.
One hundred sixty-one consecutive patients with Stage T1-T3 prostate carcinoma (according to the 1992 criteria of the American Joint Committee on Cancer) were treated from 1992 through 1996. Each patient had a Gleason score > or = 7 and/or a prostate specific antigen (PSA) level > 10 ng/mL. The original biopsy slides for 130 of 161 patients were retrieved and rereviewed by a single pathologist (L.T.). Enzymatic PAP measurements were determined using a standard method. Values up to 2.5 Units were considered normal. Patients received 41 grays (Gy) of external beam radiation therapy to a limited pelvic field followed 4 weeks later by a palladium 103 (Pd-103) boost using transrectal ultrasound and fluoroscopic guidance as described previously. The prescribed minimum Pd-103 dose to the prostate was 80 Gy (pre-National Institute of Standards and Technology [NIST]-99). Freedom from biochemical failure was defined as a serum PSA level < or =0.2 ng/mL at last follow-up.
There was little correlation between pretreatment PSA levels, Gleason scores, and PAP measurements. Thirty-eight patients developed biochemical failure. The overall actuarial freedom from biochemical progression at 10 years is 79%, with 118 patients followed for > 5 years. In a multivariate Cox proportional hazards analysis that considered each factor as a continuous variable, the strongest predictor of failure was PAP (P = 0.0001), followed by Gleason score (P = 0.13), and PSA (P = 0.04). PAP was especially helpful in stratifying patients with pretreatment PSA levels between 4 ng/mL and 20 ng/mL, for whom the prognosis does not different when they are subdivided into PSA categories. When the PAP subgroup analysis was limited to this relatively favorable group, there was a wide range of prognoses.
The biochemical cure rate was remarkably high among the 161 patients evaluated. The fact that the PAP was the strongest predictor of long-term biochemical failure in patients with otherwise higher risk features reported here suggests that it may be a more accurate indicator of micrometastatic disease compared with the Gleason score and the PSA level. This report adds to the rationale for reintroducing PAP measurement into general practice.
本研究的目的是确定前列腺酸性磷酸酶（PAP）水平在高危早期前列腺癌患者中的长期预后意义。
1992年至1996年期间，连续治疗了161例T1 - T3期前列腺癌患者（根据美国癌症联合委员会1992年标准）。每位患者的Gleason评分≥7分和/或前列腺特异性抗原（PSA）水平>10 ng/mL。从161例患者中取出130例患者的原始活检切片，由一位病理学家（L.T.）重新检查。使用标准方法测定酶促PAP测量值。高达2.5单位的值被认为是正常的。患者接受41格雷（Gy）的盆腔外照射，4周后在经直肠超声和荧光透视引导下进行钯103（Pd - 103）增敏照射，如前所述。前列腺规定的最低Pd - 103剂量为80 Gy（国家标准与技术研究院[ NIST ] - 99之前）。生化无失败定义为最后一次随访时血清PSA水平≤0.2 ng/mL。
治疗前PSA水平、Gleason评分和PAP测量值之间几乎没有相关性。38例患者出现生化失败。在118例随访超过5年的患者中，10年时生化进展的总体精算无进展率为79%。在将每个因素视为连续变量的多变量Cox比例风险分析中，失败的最强预测因素是PAP（P = 0.0001），其次是Gleason评分（P = 0.13）和PSA（P = 0.04）。PAP在对治疗前PSA水平在4 ng/mL至20 ng/mL之间的患者进行分层时特别有用，对于这些患者，当按PSA类别细分时预后无差异。当PAP亚组分析仅限于这个相对有利的组时，预后范围很广。
在评估的161例患者中，生化治愈率非常高。本文报道的PAP是具有其他较高风险特征患者长期生化失败的最强预测因素，这一事实表明，与Gleason评分和PSA水平相比，它可能是微转移疾病的更准确指标。本报告为将PAP测量重新引入一般临床实践提供了理论依据。
