Venkitaraman Ramachandran, Norman Andrew, Woode-Amissah Ruth, Dearnaley David, Horwich Alan, Huddart Robert, Parker Chris
Academic Unit of Radiotherapy & Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
BJU Int. 2008 Jan;101(2):161-4. doi: 10.1111/j.1464-410X.2007.07175.x. Epub 2007 Sep 10.
To report the results of a prospective study of active surveillance of untreated prostate cancer, with a focus on baseline predictors of prostate-specific antigen (PSA) velocity, as PSA velocity before treatment is an important predictor of prostate cancer mortality, and patients on active surveillance are monitored for several years to estimate the PSA velocity and thus select patients for radical treatment.
A prospective study of active surveillance for localized prostate cancer opened at the Royal Marsden Hospital in 2002. Eligible patients had clinical stage T1/T2a, N0/Nx, M0/Mx adenocarcinoma of the prostate with a serum PSA level of < 15 ng/mL, a Gleason score of < or = 7 with primary grade < or = 3, and less than half the biopsy cores positive. The PSA velocity before treatment was analysed in relation to baseline clinical characteristics.
In all, 237 patients on surveillance were followed for a median of 24 months (median age 67 years; median initial PSA level 6.5 ng/mL; median pretreatment PSA velocity 0.44 ng/mL per year). On multivariate analysis, PSA density (i.e. serum PSA level/prostate volume) was the only significant determinant of PSA velocity (P < 0.001). Patients with a PSA density above or below the median (0.185 ng/mL/mL) had a median (interquartile range) PSA velocity of 0.92 (0.34-1.77) ng/mL per year and 0.35 (-0.06, 0.80) ng/mL per year, respectively.
PSA density, which is readily available at the time of diagnosis, is an independent determinant of PSA velocity in untreated, localized prostate cancer. If this is confirmed, PSA density could be used to inform the often difficult choice between active surveillance and immediate radical treatment.
报告一项关于未经治疗的前列腺癌主动监测的前瞻性研究结果，重点关注前列腺特异性抗原（PSA）速度的基线预测因素，因为治疗前的PSA速度是前列腺癌死亡率的重要预测指标，且对接受主动监测的患者进行数年监测以评估PSA速度，从而选择适合根治性治疗的患者。
2002年在皇家马斯登医院开展了一项针对局限性前列腺癌主动监测的前瞻性研究。符合条件的患者为临床分期T1/T2a、N0/Nx、M0/Mx的前列腺腺癌，血清PSA水平<15 ng/mL，Gleason评分<或=7且主要分级<或=3，活检阳性核心少于一半。分析治疗前的PSA速度与基线临床特征的关系。
总共237名接受监测的患者中位随访时间为24个月（中位年龄67岁；中位初始PSA水平6.5 ng/mL；中位治疗前PSA速度为每年0.44 ng/mL）。多因素分析显示，PSA密度（即血清PSA水平/前列腺体积）是PSA速度的唯一显著决定因素（P<0.001）。PSA密度高于或低于中位数（0.185 ng/mL/mL）的患者，其PSA速度中位数（四分位间距）分别为每年0.92（0.34 - 1.77）ng/mL和每年0.35（-0.06，0.80）ng/mL。
PSA密度在诊断时即可获得，是未经治疗的局限性前列腺癌PSA速度的独立决定因素。如果这一结论得到证实，PSA密度可用于指导在主动监测和立即根治性治疗之间通常较为困难的选择。
