Arai Y, Yoshiki T, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
J Urol. 1990 Dec;144(6):1415-9. doi: 10.1016/s0022-5347(17)39757-4.
The prognostic value of prostate specific antigen was evaluated to predict disease progression after endocrine therapy in patients with prostatic cancer. A total of 73 patients was studied (6 with stage B2, 16 with stage C, 9 with stage D1 and 42 with stage D2 disease). Endocrine therapy included bilateral orchiectomy, diethylstilbestrol diphosphate and luteinizing hormone-releasing hormone analogue. Pre-treatment serum prostate specific antigen levels were determined in all patients with an enzyme immunoassay kit. During a followup of 4 to 68 months (average 24 months) clinical disease progression occurred in 24 of the 73 patients. The pre-treatment prostate specific antigen level by itself did not predict disease progression. Changes in prostate specific antigen level with treatment were correlated with the interval to disease progression in the 44 patients who had prostate specific antigen determinations at regular intervals after endocrine therapy and whose initial level was greater than 10 ng./ml. Patients who had a decrease in the prostate specific antigen levels of 80% or more within 1 month after the beginning of therapy survived significantly longer free of disease progression (p less than 0.001). Patients whose prostate specific antigen level remained elevated for more than 3 months had a high risk of disease progression within 2 years. Our study suggests that patients with the more favorable prognosis can be identified early, after 1 to 3 months of endocrine therapy, by the rapid decrease in the prostate specific antigen levels.
评估前列腺特异性抗原在预测前列腺癌患者内分泌治疗后疾病进展方面的预后价值。共研究了73例患者（6例B2期、16例C期、9例D1期和42例D2期疾病）。内分泌治疗包括双侧睾丸切除术、己烯雌酚二磷酸酯和促性腺激素释放激素类似物。使用酶免疫分析试剂盒测定所有患者治疗前的血清前列腺特异性抗原水平。在4至68个月（平均24个月）的随访期间，73例患者中有24例出现临床疾病进展。治疗前的前列腺特异性抗原水平本身并不能预测疾病进展。对于44例在内分泌治疗后定期测定前列腺特异性抗原且初始水平大于10 ng/ml的患者，治疗后前列腺特异性抗原水平的变化与疾病进展的间隔时间相关。治疗开始后1个月内前列腺特异性抗原水平降低80%或更多的患者无疾病进展存活的时间明显更长（p<0.001）。前列腺特异性抗原水平持续升高超过3个月的患者在2年内疾病进展的风险较高。我们的研究表明，在内分泌治疗1至3个月后，通过前列腺特异性抗原水平的快速下降，可以早期识别预后较好的患者。
