Miller J I, Ahmann F R, Drach G W, Emerson S S, Bottaccini M R
Department of Urology, Arizona Cancer Center, University of Arizona Health Sciences Center, Tucson.
J Urol. 1992 Mar;147(3 Pt 2):956-61. doi: 10.1016/s0022-5347(17)37432-3.
We longitudinally followed serum prostate specific antigen (PSA) levels in 48 patients who were treated with either orchiectomy, monthly luteinizing hormone-releasing hormone injection or continuous diethylstilbestrol for stage D2 prostate adenocarcinoma and achieved an objective response. Of the patients 34 had clinical evidence of disease progression (median remission duration 19 months). Median length of followup for the 14 patients who remained in remission was 42 months. Pretreatment performance status, pretreatment extent of metastases as measured by a bone scan and post-treatment nadir PSA level were univariately correlated with remission duration. After adjustment for the 2 former pretreatment variables, a highly significant independent effect of the nadir PSA level on remission duration persisted. Patients whose post-treatment nadir PSA level decreased below 4 ng./ml. had a significantly longer remission duration than those whose nadir PSA remained elevated (median 42 versus 10 months, p less than 0.0001). No cases were observed to progress (as defined by our criteria independent of PSA level) while the serial post-treatment PSA levels continued to decrease or remained at a plateau after reaching the nadir. The time at which the PSA began to increase once the nadir was reached predated objective evidence of progression in all patients except 2 in whom the 2 events occurred simultaneously (mean lead time 7.3 +/- 5.0 months). We conclude that following serial PSA levels in patients treated with androgen ablation for metastatic prostate cancer can aid in distinguishing favorable from nonfavorable responders early in the course of therapy and greatly assist in monitoring for progression.
我们对48例D2期前列腺腺癌患者进行了纵向随访，这些患者接受了睾丸切除术、每月注射促黄体生成素释放激素或持续服用己烯雌酚治疗，并取得了客观缓解。其中34例患者有疾病进展的临床证据（中位缓解持续时间为19个月）。14例仍处于缓解期患者的中位随访时间为42个月。治疗前的体能状态、通过骨扫描测量的治疗前转移范围以及治疗后最低PSA水平与缓解持续时间单因素相关。在对前两个治疗前变量进行调整后，最低PSA水平对缓解持续时间仍有高度显著的独立影响。治疗后最低PSA水平降至4 ng/ml以下的患者，其缓解持续时间明显长于最低PSA水平仍升高的患者（中位时间分别为42个月和10个月，p<0.0001）。在治疗后的系列PSA水平持续下降或达到最低点后保持平稳期间，未观察到有病例进展（根据我们不依赖PSA水平的标准定义）。除2例事件同时发生外，在所有患者中，PSA在达到最低点后开始升高的时间均早于客观进展证据（平均提前时间为7.3±5.0个月）。我们得出结论，对接受雄激素剥夺治疗的转移性前列腺癌患者随访系列PSA水平，有助于在治疗早期区分反应良好与反应不佳的患者，并极大地有助于监测疾病进展。
