Jones Timothy D, Koch Michael O, Bunde Paula J, Cheng Liang
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
BJU Int. 2006 Mar;97(3):480-4. doi: 10.1111/j.1464-410X.2006.06022.x.
To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer.
The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence.
The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40).
These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.
探讨术前前列腺特异性抗原（PSA）水平和PSA密度与若干临床及病理变量（包括根治性前列腺切除术（RP）后生化复发）之间的关系，并比较术前PSA水平和PSA密度作为前列腺癌预后因素的情况。
本研究纳入了在同一机构接受RP的348例患者，前列腺的整体标本由一名病理学家进行检查。采用单因素和多因素分析来评估术前PSA水平和PSA密度与临床及病理变量之间的关系，并通过受试者工作特征（ROC）分析来评估这两个因素作为生化复发预测指标的相对效用。
RP前的PSA水平与患者年龄（P = 0.003）、前列腺重量（P < 0.001）、癌体积（P < 0.001）和Gleason评分（P = 0.033）显著相关，并且与RP标本中的手术切缘状态和病理分期均显著相关（均P < 0.001）。在控制肿瘤分期、手术切缘状态和Gleason评分的多因素分析中，PSA水平和PSA密度均是PSA复发的显著预测因素（分别为P = 0.027和0.01）。ROC分析显示，在预测RP后PSA复发方面，PSA水平和PSA密度之间无统计学差异（P = 0.40）。
这些结果表明术前PSA水平与前列腺癌其他既定预后因素之间存在显著相关性。在多因素分析中，PSA水平和PSA密度均是PSA复发的独立预测因素。由于在预测PSA复发方面PSA水平与PSA密度同样有效，因此可能无需为计算PSA密度付出额外努力。我们建议在将患者分层至不同预后组以及确定最佳治疗方案时，考虑RP前的PSA水平。
