Moul Judd W, Bañez Lionel L, Freedland Stephen J
Division of Urologic Surgery, Duke Prostate Center, Duke University Medical Center,Durham, NC 27710, USA.
Oncology (Williston Park). 2007 Nov;21(12):1436-45; discussion 1449, 1452, 1454.
Rising prostate-specific antigen (PSA) in nonmetastatic prostate cancer occurs in two main clinical settings: (1) rising PSA to signal failed initial local therapy and (2) rising PSA in the setting of early hormone-refractory prostate cancer prior to documented clinical metastases. Most urologists and radiation oncologists are very familiar with the initial very common clinical scenario, commonly called "biochemical recurrence." In fact, up to 70,000 men each year will have a PSA-only recurrence after failed definitive therapy. The ideal salvage therapy for these men is not clear and includes salvage local therapies and systemic approaches, of which the mainstay is hormonal therapy. Treatment needs to be individualized based upon the patient's risk of progression and the likelihood of success and the risks involved with the therapy. It is unknown how many men per year progress with rising PSA while on hormonal therapy without documented metastases. This rising PSA disease state is sometimes called, "PSA-only hormone-refractory prostate cancer." As in the setting of initial biochemical recurrence, evidence-based treatment options are limited, and taking a risk-stratified approach is justified. In this article, we will explore these prostate cancer disease states with an emphasis on practical, clinically applicable approaches.
非转移性前列腺癌中前列腺特异性抗原（PSA）升高主要出现在两种临床情况中：（1）PSA升高提示初始局部治疗失败；（2）在临床转移记录之前的早期激素难治性前列腺癌情况下PSA升高。大多数泌尿外科医生和放射肿瘤学家都非常熟悉最初这种非常常见的临床情况，通常称为“生化复发”。事实上，每年多达70000名男性在确定性治疗失败后会出现仅PSA复发。这些男性的理想挽救治疗方法尚不清楚，包括挽救性局部治疗和全身治疗方法，其中主要是激素治疗。治疗需要根据患者的进展风险、成功可能性以及治疗相关风险进行个体化。每年有多少接受激素治疗但无转移记录的男性会因PSA升高而病情进展尚不清楚。这种PSA升高的疾病状态有时被称为“仅PSA激素难治性前列腺癌”。与初始生化复发情况一样，循证治疗选择有限，采用风险分层方法是合理的。在本文中，我们将探讨这些前列腺癌疾病状态，重点是实用的、临床适用的方法。
