Shariat Shahrokh F, Abdel-Aziz Khaled F, Roehrborn Claus G, Lotan Yair
Department of Urology, The University of Texas Southwestern Medical Center at Dallas, TX 75390-9110, USA.
Eur Urol. 2006 Feb;49(2):293-302. doi: 10.1016/j.eururo.2005.10.027. Epub 2005 Dec 20.
To evaluate the association of total prostate specific antigen (T-PSA) and percent free PSA (%F-PSA) with prostate cancer outcomes in patients treated with radical prostatectomy (RP).
Pre-operative serum levels of T-PSA and F-PSA were prospectively measured in 402 consecutive patients treated with RP for clinically localized prostate cancer who had T-PSA levels below 10 ng/ml.
T-PSA was not associated with any prostate cancer characteristics or outcomes. Lower %F-PSA was significantly associated with higher percent positive biopsy cores, extracapsular extension, seminal vesicle involvement, lympho-vascular invasion, perineural invasion, positive surgical margins, and higher pathologic Gleason sum. When adjusted for the effects of standard pre-operative features, lower %F-PSA significantly predicted non-organ confined disease, seminal vesicle involvement, lympho-vascular invasion, and biochemical progression. %F-PSA did not retain its association with biochemical progression after adjusting for the effects of standard post-operative features. Based on data from 22 patients with biochemical progression, lower %F-PSA was correlated with shorter T-PSA doubling time after biochemical progression (rho = 0.681, p = 0.010). %F-PSA was lower in patients who failed salvage radiation therapy (p = 0.031) and in patients who developed distant cancer metastases compared to patients who did not (p < 0.001).
Pre-operative T-PSA is not associated with prostate cancer outcomes after RP when levels are below 10 ng/ml. In contrast, pre-operative %F-PSA is associated with adverse pathologic features, biochemical progression, and features of aggressive disease progression in patients treated with RP and T-PSA levels below 10 ng/ml. %F-PSA may improve pre-operative predictive models for predicting clinical outcomes of patients diagnosed with prostate cancer nowadays.
评估在接受根治性前列腺切除术（RP）的患者中，总前列腺特异性抗原（T-PSA）和游离PSA百分比（%F-PSA）与前列腺癌预后的相关性。
对402例因临床局限性前列腺癌接受RP治疗且T-PSA水平低于10 ng/ml的连续患者，前瞻性地测定其术前血清T-PSA和F-PSA水平。
T-PSA与任何前列腺癌特征或预后均无关联。较低的%F-PSA与较高的活检阳性芯百分比、包膜外侵犯、精囊受累、淋巴管侵犯、神经周围侵犯、手术切缘阳性以及较高的病理Gleason评分显著相关。在调整了标准术前特征的影响后，较低的%F-PSA显著预测了非器官局限性疾病、精囊受累、淋巴管侵犯和生化进展。在调整了标准术后特征的影响后，%F-PSA与生化进展的相关性不再存在。基于22例生化进展患者的数据，较低的%F-PSA与生化进展后T-PSA倍增时间缩短相关（rho = 0.681，p = 0.010）。与未发生远处癌症转移的患者相比，挽救性放疗失败的患者（p = 0.031）以及发生远处癌症转移的患者%F-PSA较低（p < 0.001）。
当T-PSA水平低于10 ng/ml时，术前T-PSA与RP术后前列腺癌预后无关。相比之下，术前%F-PSA与接受RP且T-PSA水平低于10 ng/ml的患者的不良病理特征、生化进展以及侵袭性疾病进展特征相关。%F-PSA可能会改善目前用于预测前列腺癌患者临床结局的术前预测模型。
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