Kane Christopher J, Presti Joseph C, Amling Christopher L, Aronson William J, Terris Martha K, Freedland Stephen J
Urology Section, Department of Surgery, Veterans Administration Medical Center San Francisco, San Francisco, USA.
J Urol. 2007 Jan;177(1):113-7. doi: 10.1016/j.juro.2006.08.057.
We examined the outcomes of radical prostatectomy alone in high risk patients with prostate cancer and evaluated changes in high risk prostate cancer outcomes with time.
From 1988 to 2003, 251 men with high risk prostate cancer (prostate specific antigen more than 20 ng/ml and/or biopsy Gleason greater than 7) were identified in a cohort of 1,796 (14%) enrolled in the Shared Equal Access Regional Cancer Hospital Database. Temporal changes in clinicopathological characteristics and prostate specific antigen recurrence rates were examined stratified by 4, 4-year periods.
With time significantly more men were considered at high risk due to a high biopsy Gleason score relative to prior years, when the most common reason for being considered at high risk was increased PSA (p <0.001). Only 3% of high risk men from 2000 to 2003 had increased prostate specific antigen and high biopsy Gleason score compared to 23% from 1988 to 1991. With time there were no differences in biochemical recurrence rates (p = 0.147). Men with a high biopsy Gleason score and increased prostate specific antigen had worse outcomes than men with only a high Gleason score or men with only high prostate specific antigen (p = 0.046 and 0.081, respectively). On multivariate analysis that only included preoperative clinical characteristics only prostate specific antigen was an independent predictor of prostate specific antigen failure following radical prostatectomy (p = 0.014). There was a trend, which did not attain statistical significance, for higher biopsy Gleason scores and higher clinical stage to be associated with higher failure rates (p = 0.060 and 0.081, respectively).
Patients are designated as high risk by Gleason grade more commonly now than early in the prostate specific antigen era. Outcomes in high risk patients undergoing radical prostatectomy alone have not significantly improved with time. New treatment strategies, such as multimodality therapy, are needed to improve outcomes in high risk patients with prostate cancer.
我们研究了高危前列腺癌患者单纯根治性前列腺切除术的疗效，并评估了高危前列腺癌疗效随时间的变化。
1988年至2003年期间，在共享平等准入区域癌症医院数据库登记的1796名患者（14%）队列中，识别出251例高危前列腺癌患者（前列腺特异性抗原超过20 ng/ml和/或活检Gleason评分大于7）。按4个4年时间段分层，研究临床病理特征和前列腺特异性抗原复发率的时间变化。
随着时间推移，与前几年相比，因活检Gleason评分高而被视为高危的男性显著增多，此前被视为高危的最常见原因是前列腺特异性抗原升高（p<0.001）。2000年至2003年期间，只有3%的高危男性前列腺特异性抗原升高且活检Gleason评分高，而1988年至1991年为23%。随着时间推移，生化复发率无差异（p = 0.147）。活检Gleason评分高且前列腺特异性抗原升高的男性比仅Gleason评分高或仅前列腺特异性抗原高的男性预后更差（分别为p = 0.046和0.081）。在仅纳入术前临床特征的多因素分析中，只有前列腺特异性抗原是根治性前列腺切除术后前列腺特异性抗原失败的独立预测因素（p = 0.014）。活检Gleason评分越高和临床分期越高与失败率越高相关，但未达到统计学意义（分别为p = 0.060和0.081）。
现在与前列腺特异性抗原时代早期相比，Gleason分级将患者指定为高危更为常见。单纯接受根治性前列腺切除术的高危患者的疗效并未随时间显著改善。需要新的治疗策略，如多模式治疗，以改善高危前列腺癌患者的疗效。
