Miyake Hideaki, Hara Isao, Kurahashi Toshifumi, Muramaki Mototsugu, Yamanaka Kazuki, Inoue Taka-aki, Fujisawa Masato
Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan.
Urol Int. 2006;77(3):200-4. doi: 10.1159/000094809.
The objective of this study was to characterize clinicopathological features of patients with biochemical recurrence after radical prostatectomy who did not exhibit a progressive rise in serum prostate-specific antigen (PSA) during the follow-up period.
We analyzed data from 162 consecutive patients who underwent radical prostatectomy for clinically organ-confined prostate cancer without neoadjuvant hormonal therapy and were followed postoperatively for at least 1 year. The serum PSA value was measured using an ultrasensitive PSA assay system (Roche Diagnostics, Mannheim, Germany), and biochemical recurrence was defined as a serum PSA of >or=0.1 ng/ml.
A total of 32 patients (19.8%) were diagnosed as having biochemical recurrence. Among these patients, we identified 10 (31.3%) with a serum PSA>0.1 ng/ml who had not shown PSA or clinical progression during a median follow-up of 34 months after radical prostatectomy. In these 10 patients, the median time to biochemical recurrence was 17 months, the median PSA velocity after biochemical recurrence was 0.034 ng/ml/year, and there was no patient whose serum PSA value became >0.4 ng/ml. There were no clinicopathological parameters except for PSA velocity that were significantly associated with the features of these 10 patients.
Because of the presence of a subset of patients with biochemical recurrence after radical prostatectomy who will not show a progressive increase in serum PSA value, the indication for adjuvant therapy for such patients should be cautiously determined considering several factors, such as PSA kinetics.
本研究的目的是描述根治性前列腺切除术后生化复发患者的临床病理特征，这些患者在随访期间血清前列腺特异性抗原（PSA）未呈进行性升高。
我们分析了162例连续接受根治性前列腺切除术治疗临床局限性前列腺癌且未接受新辅助激素治疗的患者的数据，并在术后随访至少1年。使用超敏PSA检测系统（德国曼海姆罗氏诊断公司）测量血清PSA值，生化复发定义为血清PSA≥0.1 ng/ml。
共有32例患者（19.8%）被诊断为生化复发。在这些患者中，我们确定了10例（31.3%）血清PSA>0.1 ng/ml的患者，他们在根治性前列腺切除术后中位随访34个月期间未出现PSA或临床进展。在这10例患者中，生化复发的中位时间为17个月，生化复发后的中位PSA速度为0.034 ng/ml/年，且没有患者的血清PSA值>0.4 ng/ml。除PSA速度外，没有其他临床病理参数与这10例患者的特征显著相关。
由于根治性前列腺切除术后存在一部分生化复发患者血清PSA值不会呈进行性升高，因此对于此类患者辅助治疗的指征应谨慎确定，需考虑多个因素，如PSA动力学。
