D'Amico Anthony
Genitourinary Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
BJU Int. 2007 Jan;99 Suppl 1:13-6; discussion 17-8. doi: 10.1111/j.1464-410X.2007.06594.x.
Prostate-specific antigen doubling time (PSA-DT) after surgery or radiotherapy (RT) is known to be a predictive factor for death from prostate cancer (prostate cancer-specific mortality, PCSM). An analysis of two multi-institutional databases, including 8669 men with prostate cancer treated with surgery or RT, found that a PSA-DT of <3 months, and the specific value of the PSA-DT when > or = 3 months, appeared to be surrogate endpoints for PCSM after surgery or RT. While many PSA failures occur after local therapy for localized prostate cancer, few of these patients go on to die from their disease, so it is important to identify other factors associated with PCSM, so that the subgroup of high-risk patients can be identified. An analysis was undertaken to determine whether patients at risk of PCSM could be identified using information available at diagnosis. The results showed that risk factors for PCSM were a PSA velocity of >2.0 ng/mL/year, a Gleason score of 8-10 and an increasing PSA level. However, the most important risk factor that had an impact on both PCSM and all-cause mortality was a PSA velocity of >2.0 ng/mL/year. PSA kinetics are being increasingly used in the setting of rising PSA levels after radical prostatectomy or RT, and several studies showed that the rate of increase in PSA level at the time of recurrence is closely associated with time to cancer death. A PSA-DT of <3 months is associated with a poor prognosis, and represents 15-20% of PSA failures in the general population and 6-7% of PSA failures in a screened population, such as those included in clinical trials. Better risk-assessment models are needed to help to identify at an early stage men who are at high risk of prostate cancer death and those who are at low risk, so that each subgroup can receive the most appropriate therapy for their disease.
手术后或放疗后的前列腺特异性抗原倍增时间（PSA-DT）已知是前列腺癌死亡（前列腺癌特异性死亡率，PCSM）的一个预测因素。对两个多机构数据库进行分析，纳入了8669例接受手术或放疗的前列腺癌男性患者，结果发现PSA-DT<3个月以及PSA-DT≥3个月时的具体数值，似乎是手术后或放疗后PCSM的替代终点。虽然局部前列腺癌局部治疗后会出现许多PSA失败情况，但这些患者中很少有人最终死于该疾病，因此识别与PCSM相关的其他因素很重要，以便能够识别出高危患者亚组。进行了一项分析以确定是否可以使用诊断时可用的信息来识别有PCSM风险的患者。结果显示，PCSM的风险因素包括PSA速率>2.0 ng/mL/年、Gleason评分8 - 10分以及PSA水平升高。然而，对PCSM和全因死亡率都有影响的最重要风险因素是PSA速率>2.0 ng/mL/年。PSA动力学越来越多地用于根治性前列腺切除术后或放疗后PSA水平上升的情况，多项研究表明复发时PSA水平的升高速率与癌症死亡时间密切相关。PSA-DT<3个月与预后不良相关，在一般人群中占PSA失败的15 - 20%，在筛查人群（如临床试验中的人群）中占PSA失败的6 - 7%。需要更好的风险评估模型来帮助早期识别前列腺癌死亡高风险和低风险的男性，以便每个亚组都能接受最适合其疾病的治疗。
