Aranha Olivia, Vaishampayan Ulka
Division of Hematology/Oncology, Department of Internal Medicine, Karmanos Cancer Institute and Wayne State University School of Medicine, Detroit, MI, USA.
Urol Oncol. 2004 Jan-Feb;22(1):62-9. doi: 10.1016/j.urolonc.2003.12.002.
Prostate specific antigen (PSA) is an invaluable tumor marker in the detection of early prostate cancer as well as a predictor of recurrence after treatment of localized disease. Current practice entails the use of factors such as pretherapy grade, stage and PSA, PSA doubling time, nature of previous therapy and patient age and functional status for a treatment recommendation. For a PSA relapse post radical prostatectomy, radiation therapy to the prostatic fossa is a primary therapeutic consideration. With careful patient selection, about 30 to 40% of patients are rendered disease free using this approach. For patients with radiation therapy as the primary treatment for their prostate cancer, salvage prostatectomy can be considered, but is rarely feasible. Systemic therapy with hormones is standard if patients are not candidates for the above mentioned salvage local therapies or if they relapse after exhaustive local therapies. Unfortunately androgen suppressive therapy is unlikely to induce cure, or prolonged remissions in PSA relapse prostate cancer. The strategy of addition of chemotherapy or biologic therapy to androgen suppressive therapy is under active investigation. The goal of this therapy is to make an impact on the time to progression to metastatic prostate cancer and correspondingly decrease prostate cancer related mortality. Preliminary results of studies incorporating early chemotherapy in combination with androgen suppressive therapy are encouraging, with improvement in time to progression and overall survival. The evaluation of biologic agents and agents with better toxicity profiles is ongoing. This is very important to make therapy widely applicable and to enable prolonged administration especially in a disease such as prostate cancer with a relatively long natural history. Strategies of adjuvant and neoadjuvant therapy in locally advanced prostate cancer are exploring the possibility of reducing the chance of PSA relapse by treating micrometastatic disease. This review discusses the current practices in risk stratification and management of PSA relapse prostate cancer. It also highlights the major clinical trials and areas of active investigation in this field.
前列腺特异性抗原（PSA）是早期前列腺癌检测中一项非常重要的肿瘤标志物，也是局限性疾病治疗后复发的预测指标。目前的临床实践中，在给出治疗建议时会考虑多种因素，如治疗前分级、分期和PSA、PSA倍增时间、既往治疗的性质以及患者年龄和功能状态。对于根治性前列腺切除术后出现PSA复发的情况，对前列腺窝进行放射治疗是主要的治疗考虑。经过仔细挑选患者，采用这种方法约30%至40%的患者可实现无病状态。对于以放射治疗作为前列腺癌主要治疗方式的患者，可以考虑挽救性前列腺切除术，但很少可行。如果患者不适合上述挽救性局部治疗，或者在进行了彻底的局部治疗后复发，则激素全身治疗是标准治疗方法。不幸的是，雄激素抑制疗法不太可能治愈PSA复发的前列腺癌，也不太可能诱导长期缓解。在雄激素抑制疗法中添加化疗或生物疗法的策略正在积极研究中。这种疗法的目标是对进展为转移性前列腺癌的时间产生影响，并相应降低前列腺癌相关死亡率。将早期化疗与雄激素抑制疗法联合应用的研究初步结果令人鼓舞，进展时间和总生存率均有所改善。对生物制剂和毒性特征更好的药物的评估正在进行中。这对于使治疗广泛适用并能够长期给药非常重要，尤其是在前列腺癌这种自然病程相对较长的疾病中。局部晚期前列腺癌的辅助和新辅助治疗策略正在探索通过治疗微转移疾病来降低PSA复发几率的可能性。本综述讨论了PSA复发前列腺癌风险分层和管理的当前实践。它还强调了该领域的主要临床试验和积极研究领域。
