Shimizu Fumitaka, Igarashi Ataru, Fukuda Takashi, Kawachi Yoshio, Minowada Shigeru, Ohashi Yasuo, Fujime Makoto
Department of Urology, Juntendo University, 2-1-1Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Jpn J Clin Oncol. 2007 Oct;37(10):763-74. doi: 10.1093/jjco/hym105. Epub 2007 Oct 22.
The introduction of prostate-specific antigen (PSA) testing has not only shortened the time required to make diagnosis but changed the treatment strategies of localized prostate cancer. We conducted the decision analysis on its treatment focusing on patients with biochemical failure.
We developed a Markov model to calculate life expectancy (LE) and quality-adjusted life expectancy (QALE) stratified by age, comorbidity and tumor characteristics in patients with newly diagnosed prostate cancer or biochemical failure after curative therapy. For newly diagnosed patients, three treatment strategies were considered as primary managements: radial prostatectomy (RP), external beam radiotherapy (EBRT) and watchful waiting (WW). Managements considered for biochemical failure were: after RP, salvage radiotherapy (SRT), salvage hormonal therapy (SHT) and WW; and after EBRT, SHT and WW. Transition probabilities in the Markov model were derived from published studies. Quality of life (QOL) data to estimate QALE score were derived from 323 patients with prostate cancer.
For patients with Gleason 2-6 cancer at diagnosis, WW yielded the greatest number of QALE. For patients with Gleason 7 cancer, it was controversial whether curative therapy was the preferred strategy. For patients with Gleason 8-10 cancer, curative therapy yielded the greatest number of QALE in younger patients without severe comorbidity. Patients' benefit from salvage therapy for biochemical failure after curative therapy depended on age, comorbidities, tumor characteristics and QOL effect.
Our findings support the need for various treatment options, taking into consideration the patient's age, comorbidity and the QOL effect in the aging society.
前列腺特异性抗原（PSA）检测的引入不仅缩短了诊断所需时间，还改变了局限性前列腺癌的治疗策略。我们针对其治疗进行了决策分析，重点关注生化复发的患者。
我们建立了一个马尔可夫模型，以计算新诊断前列腺癌患者或根治性治疗后生化复发患者按年龄、合并症和肿瘤特征分层的预期寿命（LE）和质量调整预期寿命（QALE）。对于新诊断的患者，三种治疗策略被视为主要管理方式：根治性前列腺切除术（RP）、外照射放疗（EBRT）和观察等待（WW）。针对生化复发考虑的管理方式为：RP后，挽救性放疗（SRT）、挽救性激素治疗（SHT）和WW；EBRT后，SHT和WW。马尔可夫模型中的转移概率来自已发表的研究。用于估计QALE评分的生活质量（QOL）数据来自323例前列腺癌患者。
对于诊断时Gleason 2 - 6级癌症的患者，WW产生的QALE数量最多。对于Gleason 7级癌症的患者，根治性治疗是否为首选策略存在争议。对于Gleason 8 - 10级癌症的患者，在没有严重合并症的年轻患者中，根治性治疗产生的QALE数量最多。患者从根治性治疗后生化复发的挽救性治疗中获得的益处取决于年龄、合并症、肿瘤特征和QOL效应。
我们的研究结果支持在老龄化社会中，考虑患者年龄、合并症和QOL效应，需要多种治疗选择。
