Eastham James A
Department of Urology at Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Nat Clin Pract Urol. 2005 Oct;2(10):482-91. doi: 10.1038/ncpuro0321.
Prostate cancer has a varied natural history. Men with similar serum prostate-specific antigen (PSA) levels, clinical stages, and histologic features in their tissue specimens can have markedly different outcomes. While prostate cancer is lethal in some patients, most men die with cancer rather than because of it. Moreover, histologically apparent cancer can be found in the prostate glands of approximately 42% of men over 50 years of age who die from other causes, but the lifetime risk that a man in the US will be diagnosed with prostate cancer is estimated to be 11% and the risk of dying from the disease is only 3.1%. Consequently, appropriate disease management requires risk assessment. How likely is it that a given man's cancer will progress or metastasize over his remaining lifetime? What is the probability of successful treatment? What are the risks of adverse effects and complications of each treatment? Physicians use a variety of clinical and pathologic parameters to assess the risk that a given cancer poses to an individual patient. In addition to the accepted parameters of serum PSA level, clinical staging, and pathologic grading and staging, PSA doubling time has emerged as an important factor in the evaluation of men with newly diagnosed prostate cancer or prostate cancer that recurs after treatment. PSA doubling time can also be used as a surrogate marker for prostate cancer-specific death. This review summarizes current knowledge regarding the role of PSA doubling time as a prognostic marker in men with prostate cancer.
前列腺癌具有多种自然病程。组织标本中血清前列腺特异性抗原（PSA）水平、临床分期及组织学特征相似的男性，其预后可能显著不同。虽然前列腺癌在某些患者中是致命的，但大多数男性是死于其他疾病而非前列腺癌。此外，在死于其他原因的50岁以上男性中，约42%的前列腺腺体内可发现组织学上明显的癌，但美国男性一生中被诊断为前列腺癌的风险估计为11%，死于该病的风险仅为3.1%。因此，恰当的疾病管理需要进行风险评估。特定男性的癌症在其剩余寿命中进展或转移的可能性有多大？成功治疗的概率是多少？每种治疗的不良反应和并发症风险是什么？医生使用多种临床和病理参数来评估特定癌症对个体患者构成的风险。除了公认的血清PSA水平、临床分期以及病理分级和分期参数外，PSA倍增时间已成为评估新诊断前列腺癌或治疗后复发前列腺癌男性患者的一个重要因素。PSA倍增时间也可作为前列腺癌特异性死亡的替代标志物。本综述总结了目前关于PSA倍增时间作为前列腺癌男性患者预后标志物作用的相关知识。
