University Hospital Würzburg, Department of Urology and Pediatric Urology, Germany.
Eur Urol. 2010 Jul;58(1):1-7; discussion 10-1. doi: 10.1016/j.eururo.2010.03.001. Epub 2010 Mar 17.
Prostate cancer (PCa) patients with pretreatment prostate-specific antigen (PSA) >20 ng/ml have a high risk of biochemical and clinical failure and even cancer-related death after local therapy. Pretreatment predictors of outcome after radical prostatectomy (RP) in this patient group are necessary.
Our aim was to assess how the use of additional high-risk factors (biopsy Gleason score [bGS] > or = 8 or clinical stage 3-4) can improve prediction of treatment failure and cancer-related death after RP in patients with PSA >20.
DESIGN, SETTING, AND PARTICIPANTS: In a retrospective multicentre cohort study from six European centres between 1987 and 2005, 712 patients with PSA >20 ng/ml underwent RP and bilateral pelvic lymphadenectomy.
Subgroups were analysed to determine the relationship between the number of high-risk factors and histopathology, biochemical progression-free survival, clinical evidence of progressive disease, prostate cancer-specific mortality (PCSM), and overall mortality. Kaplan-Meier analysis with log-rank test and Cox multivariable analysis were applied.
Median follow-up was 77 mo. The number of high-risk factors was significantly associated with unfavourable histopathology. Among patients with only PSA >20 ng/ml, 33% had pT2 PCa, 57.9% had bGS <7, 54% had negative surgical margins, and 85% were lymph node negative (pN0), whereas among patients with all three high-risk factors, 4.5% had pT2 PCa, 2.3% had bGS <7, 20.5% had negative margins, and 49% were pN0 (p<0.001). The strongest predictor of progression and mortality was bGS. PSA >20 ng/ml associated with bGS < or =7 resulted in 10-yr PCSM of 5%; when associated with bGS > or =8, PCSM was 35%. The main limitations of the study were retrospective design and varying treatment modalities.
PCa patients with PSA >20 ng/ml have varying risk levels of disease progression and PCSM. Considering additional risk factors further stratifies this group into four subgroups that can guide the clinician in preoperative patient counselling.
治疗前前列腺特异性抗原（PSA）>20ng/ml 的前列腺癌（PCa）患者在局部治疗后发生生化和临床失败甚至与癌症相关的死亡的风险较高。在该患者群体中，根治性前列腺切除术（RP）后治疗结果的预测需要考虑预处理因素。
我们的目的是评估在 PSA>20ng/ml 的患者中，使用额外的高危因素（活检 Gleason 评分[bGS]≥8 或临床分期 3-4）是否可以改善 RP 后治疗失败和与癌症相关的死亡的预测。
设计、地点和参与者：在 1987 年至 2005 年期间，来自欧洲六个中心的回顾性多中心队列研究中，712 名 PSA>20ng/ml 的患者接受了 RP 和双侧盆腔淋巴结切除术。
对亚组进行分析，以确定高危因素数量与组织病理学、生化无进展生存、临床进展性疾病证据、前列腺癌特异性死亡率（PCSM）和总死亡率之间的关系。采用 Kaplan-Meier 分析和对数秩检验以及 Cox 多变量分析。
中位随访时间为 77 个月。高危因素的数量与不良组织病理学显著相关。在仅 PSA>20ng/ml 的患者中，33%的患者为 pT2 PCa，57.9%的患者 bGS<7，54%的患者切缘阴性，85%的患者淋巴结阴性（pN0），而在所有三个高危因素的患者中，4.5%的患者为 pT2 PCa，2.3%的患者 bGS<7，20.5%的患者切缘阴性，49%的患者淋巴结阴性（p<0.001）。进展和死亡的最强预测因素是 bGS。PSA>20ng/ml 与 bGS<7 相关导致 10 年 PCSM 为 5%；当与 bGS≥8 相关时，PCSM 为 35%。该研究的主要局限性是回顾性设计和不同的治疗方式。
PSA>20ng/ml 的 PCa 患者具有不同的疾病进展和 PCSM 风险水平。考虑到额外的危险因素可以进一步将该组分为四个亚组，从而指导临床医生进行术前患者咨询。
