Matzkin H, Eber P, Todd B, van der Zwaag R, Soloway M S
Department of Urology, University of Miami School of Medicine, Florida 33101.
Cancer. 1992 Nov 1;70(9):2302-9. doi: 10.1002/1097-0142(19921101)70:9<2302::aid-cncr2820700915>3.0.co;2-2.
The prognostic value was determined of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) measured before and after endocrine treatment in 57 patients with newly diagnosed Stage D2 prostatic cancer.
Therapy included orchiectomy or administration of luteinizing hormone releasing hormone analogues or an antiandrogen.
The absolute pretreatment PSA (elevated in 100% of patients) but not PAP (abnormal in 93%) predicted disease progression (P < 0.0011), i.e., a poor response to therapy. Fifty-three patients responded to androgen deprivation with a decrease in PSA level. This declined to normal at 3 and 6 months in 25% of patients. Forty-nine percent had a greater than 90% decrease in their PSA level. By 1 year, 58% of patients had progressive disease. Both the nadir PSA level and the percent decline from the pretreatment level at 3 and 6 months predicted the progression-free interval (P < 0.001). Patients with a 90% or greater decline in PSA had a prolonged progression-free survival. Serial PAP levels were similarly prognostic.
It was concluded that PSA was better than PAP in evaluating patients before and after androgen-deprivation therapy. The nadir level of both markers was an important tool to predict progression-free survival in patients with metastatic prostatic cancer.
对57例新诊断为D2期前列腺癌的患者，测定了内分泌治疗前后的前列腺特异性抗原（PSA）和前列腺酸性磷酸酶（PAP），以确定其预后价值。
治疗方法包括睾丸切除术、给予促黄体生成素释放激素类似物或抗雄激素药物。
治疗前的绝对PSA水平（100%的患者升高）而非PAP水平（93%异常）可预测疾病进展（P<0.0011），即对治疗反应不佳。53例患者对雄激素剥夺治疗有反应，PSA水平下降。25%的患者在3个月和6个月时PSA水平降至正常。49%的患者PSA水平下降超过90%。到1年时，58%的患者出现疾病进展。PSA最低点水平以及3个月和6个月时相对于治疗前水平的下降百分比均可预测无进展生存期（P<0.001）。PSA下降90%或更多的患者无进展生存期延长。连续的PAP水平同样具有预后价值。
得出结论，在评估雄激素剥夺治疗前后的患者时，PSA比PAP更好。两种标志物的最低点水平是预测转移性前列腺癌患者无进展生存期的重要工具。
