Lin Darlene D, Schultz Delray, Renshaw Andrew A, Rubin Mark A, Richie Jerome P, D'Amico Anthony V
Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Urology. 2005 Mar;65(3):528-32. doi: 10.1016/j.urology.2004.10.041.
To determine the preoperative and postoperative predictors of a short prostate-specific antigen (PSA) doubling time (PSADT) after radical prostatectomy for patients diagnosed during the PSA era.
Between 1989 and 2003, 1785 men underwent radical prostatectomy for 2002 American Joint Committee on Cancer (AJCC) Stage T1c or T2 prostate cancer. Of these men, 205 had documented PSA failure. The PSADT was calculated by assuming first-order kinetics and using a minimum of two detectable postoperative PSA measurements after a previous undetectable level. Multivariable logistic regression analyses were performed to determine the significant preoperative and postoperative predictors of a PSADT of less than 6 months.
Patients with a greater biopsy Gleason score (P = 0.006), greater preoperative risk group (P = 0.002), greater prostatectomy Gleason score (P = 0.0006), greater 2002 AJCC pathologic stage (P = 0.01), or shorter time to postoperative PSA failure (P = 0.04) were more likely to have a shorter PSADT. Using multivariable analysis, high-risk disease (P = 0.0001) was the only preoperative factor that remained an independent significant predictor of a PSADT of less than 6 months. Of the postoperative factors, a prostatectomy Gleason score of 8 to 10 (P = 0.002), 2002 AJCC pathologic Stage T3b (P = 0.03), and time to PSA failure of less than 2 years (P = 0.05) remained significant independent predictors of a PSADT of less than 6 months.
High-risk disease preoperatively and a prostatectomy Gleason score of 8 to 10, seminal vesicle invasion, or a time to PSA failure of less than 2 years postoperatively were significant independent indicators of developing a postoperative PSADT of less than 6 months. For these men, trials studying systemic therapy in addition to radical prostatectomy are needed.
确定在前列腺特异性抗原（PSA）时代被诊断出的患者，根治性前列腺切除术后前列腺特异性抗原倍增时间（PSADT）短的术前和术后预测因素。
1989年至2003年间，1785名男性因2002年美国癌症联合委员会（AJCC）T1c期或T2期前列腺癌接受了根治性前列腺切除术。在这些男性中，205人有PSA失败的记录。PSADT通过假设一级动力学并使用先前不可检测水平后至少两次可检测的术后PSA测量值来计算。进行多变量逻辑回归分析以确定PSADT小于6个月的显著术前和术后预测因素。
活检Gleason评分更高（P = 0.006）、术前风险组更高（P = 0.002）、前列腺切除术后Gleason评分更高（P = 0.0006）、2002年AJCC病理分期更高（P = 0.01）或术后PSA失败时间更短（P = 0.04）的患者更有可能有较短的PSADT。使用多变量分析，高危疾病（P = 0.0001）是唯一仍然是PSADT小于6个月的独立显著术前预测因素。在术后因素中，前列腺切除术后Gleason评分为8至10（P = 0.002）、2002年AJCC病理分期T3b期（P = 0.03）以及PSA失败时间小于2年（P = 0.05）仍然是PSADT小于6个月的显著独立预测因素。
术前高危疾病以及前列腺切除术后Gleason评分为8至10、精囊侵犯或术后PSA失败时间小于2年是术后PSADT小于6个月发展的显著独立指标。对于这些男性，除了根治性前列腺切除术外，还需要研究全身治疗的试验。
