Patel Deep A, Presti Joseph C, McNeal John E, Gill Harcharan, Brooks James D, King Christopher R
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305-5847, USA.
J Clin Oncol. 2005 Sep 1;23(25):6157-62. doi: 10.1200/JCO.2005.01.2336.
Preoperative prostate-specific antigen (PSA) velocity (PSAV), or the rate of PSA rise before diagnosis, predicts for risk of cancer death after radical prostatectomy (RP). We evaluated the relative merit of established preoperative factors, including biopsy indices and preoperative PSAV, for their impact on relapse after RP.
The outcomes of 202 men who underwent RP were reviewed. Biopsies were characterized for grade, percentage positive cores, and total linear tumor length. Surgical specimens were characterized for cancer volume, relative percentage by grade, extracapsular extension, and margin status. Univariate and multivariate analyses were performed with respect to relapse-free survival after RP.
Thirty-one patients relapsed after RP (defined as PSA > or = 0.2 ng/mL), with a median time to failure of 16 months. Median follow-up was 48 months. Kaplan-Meier relapse-free survival at 5 years was 89%, compared with 73% for PSAV < or = 2 v > 2 ng/mL/year (P = .003). On multivariate analysis, only the biopsy Gleason sum (P < .008; relative risk, > 4.8) and the preoperative PSAV (P < .04; relative risk, 3.0 to 4.7) remained significant. Patients with a PSAV of > 2 ng/mL/year were more likely to be pT3 (P = .007), have positive margins (P = .01), have tumors > 1 mL (P = .05), and possess > 10% grade 4/5 tumors (P = .04).
The preoperative PSAV is a significant independent clinical factor predicting for relapse after RP and also predicts for larger, more aggressive, and more locally advanced tumors. Its inclusion will be useful in risk stratification, evaluation for alternatives to surgery, and patient selection for neoadjuvant or adjuvant therapies as part of randomized clinical trials.
术前前列腺特异性抗原（PSA）速率（PSAV），即诊断前PSA升高的速率，可预测根治性前列腺切除术（RP）后癌症死亡风险。我们评估了包括活检指标和术前PSAV在内的既定术前因素对RP后复发的影响的相对价值。
回顾了202例行RP的男性患者的结果。对活检标本的分级、阳性核心百分比和肿瘤总线性长度进行了特征分析。对手术标本的癌体积、分级相对百分比、包膜外侵犯和切缘状态进行了特征分析。对RP后的无复发生存率进行了单因素和多因素分析。
31例患者RP后复发（定义为PSA≥0.2 ng/mL），中位失败时间为16个月。中位随访时间为48个月。5年时Kaplan-Meier无复发生存率为89%，而PSAV≤2与＞2 ng/mL/年相比为73%（P = 0.003）。多因素分析显示，只有活检Gleason评分总和（P＜0.008；相对风险，＞4.8）和术前PSAV（P＜0.04；相对风险，3.0至4.7）仍具有显著性。PSAV＞2 ng/mL/年的患者更可能为pT3（P = 0.007）、切缘阳性（P = 0.01）、肿瘤＞1 mL（P = 0.05）以及有＞10%的4/5级肿瘤（P = 0.04）。
术前PSAV是预测RP后复发的重要独立临床因素，也可预测更大、更具侵袭性和局部进展性更高的肿瘤。将其纳入有助于风险分层、评估手术替代方案以及作为随机临床试验一部分的新辅助或辅助治疗的患者选择。
