Zhou Ping, Chen Ming-Hui, McLeod David, Carroll Peter R, Moul Judd W, D'Amico Anthony V
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.
J Clin Oncol. 2005 Oct 1;23(28):6992-8. doi: 10.1200/JCO.2005.01.2906.
We evaluated predictors of prostate cancer-specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT).
A total of 1,159 men with clinically localized prostate cancer treated with RP (n = 498) or RT (n = 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure.
A post-RP PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-RT PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v > or = 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of > or = 8 v < or = 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT > or = 3 months.
Patients at high risk for PCSM after PSA failure can be identified based on post-RP PSA-DT or post-RT PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel.
我们评估了根治性前列腺切除术（RP）或放射治疗（RT）后前列腺特异性抗原（PSA）失败后前列腺癌特异性死亡率（PCSM）的预测因素。
共有1159例临床局限性前列腺癌患者接受了RP（n = 498）或RT（n = 661）治疗后出现PSA失败，他们构成了研究队列。采用竞争风险回归分析来评估先前确定的转移时间预测因素，包括治疗后PSA倍增时间（PSA-DT）、Gleason评分和PSA失败间隔时间，是否也能预测PSA失败后的PCSM时间。采用累积发病率法估计PSA失败后的PCSM。
RP后PSA-DT小于3个月（风险比[HR]，54.9；95%可信区间[CI]，16.7至180）、RT后PSA-DT小于3个月（HR，12.8；95%CI，7.0至23.1）以及RT治疗患者的活检Gleason评分为8至10（HR，6.1；95%CI，3.4至10.7）与PCSM显著相关。PSA失败后5年，RP后PSA-DT小于3个月的患者PCSM估计率为31%（95%CI，17%至45%），而PSA-DT大于或等于3个月的患者为1%（95%CI，0%至2%）。PSA失败后5年，RT后活检Gleason评分大于或等于8且PSA-DT小于3个月的患者PCSM估计率分别为75%（95%CI，59%至92%）和35%（95%CI，24%至47%）；PSA-DT大于或等于3个月的患者，这些比率分别为15%（95%CI，0.8%至28%）和4%（95%CI，1%至6%）。
基于RP后PSA-DT或RT后PSA-DT以及活检Gleason评分，可以识别出PSA失败后PCSM高风险患者。这些参数可能有助于识别患者进行评估含或不含多西他赛激素治疗的随机试验。
