Departments of Urology and Pathology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
J Clin Oncol. 2010 Jun 10;28(17):2810-6. doi: 10.1200/JCO.2009.25.7311. Epub 2010 May 3.
To assess the predictive ability of prostate-specific antigen (PSA) velocity (PSAV) and doubling time (PSADT) for biopsy progression and adverse pathology at prostatectomy among men with low-risk prostate cancer enrolled on an active-surveillance program.
We evaluated 290 men who met criteria for active surveillance (ie, PSA density < 0.15 ng/mL/cm(3) and Gleason score < or = 6 with no pattern > or = 4, involving < or = 2 cores with cancer, and < or = 50% involvement of any core by cancer) with two or more serial PSA measurements after diagnosis from 1994 to 2008. Follow-up included twice-yearly digital rectal exam and PSA measurements and yearly surveillance biopsy. Treatment was recommended for biopsy progression (ie, Gleason score > or = 7, or > 2 positive cores, or > 50% core involvement). Sensitivity and specificity of postdiagnostic PSAV and PSADT were explored by using receiver operating characteristic (ROC) analysis.
Overall, 188 (65%) men remained on active surveillance, and 102 (35%) developed biopsy progression at a median follow-up of 2.9 years. PSADT was not significantly associated with subsequent adverse biopsy findings (P = .83), and PSAV was marginally significant (P = .06). No PSAV or PSADT cut point had both high sensitivity and specificity (area under the curve, 0.61 and 0.59, respectively) for biopsy progression. In those who eventually underwent radical prostatectomy, PSAV (P = .79) and PSADT (P = .87) were not associated with the presence of unfavorable surgical pathology.
Postdiagnostic PSA kinetics do not reliably predict adverse pathology and should not be used to replace annual surveillance biopsy for monitoring men on active surveillance.
评估前列腺特异性抗原（PSA）速度（PSAV）和倍增时间（PSADT）在接受主动监测方案的低危前列腺癌男性中预测前列腺活检进展和术后不良病理的能力。
我们评估了 290 名符合主动监测标准的男性（即 PSA 密度<0.15ng/mL/cm(3)和 Gleason 评分<或=6 且无模式>或=4，累及<或=2 个癌核心，且任何核心的癌症累及<或=50%），这些男性在 1994 年至 2008 年期间接受了两次或两次以上的 PSA 连续测量。随访包括每年一次的数字直肠检查和 PSA 测量以及每年一次的监测活检。建议对活检进展（即 Gleason 评分>或=7，或>2 个阳性核心，或>50%核心受累）进行治疗。使用接受者操作特征（ROC）分析探讨了诊断后 PSAV 和 PSADT 的敏感性和特异性。
总体而言，188 名（65%）男性继续接受主动监测，102 名（35%）男性在中位随访 2.9 年后发生了活检进展。PSADT 与随后的不良活检结果无显著相关性（P=0.83），PSAV 则有轻微的相关性（P=0.06）。没有 PSAV 或 PSADT 截断值在预测活检进展方面既具有高敏感性又具有高特异性（曲线下面积分别为 0.61 和 0.59）。在最终接受根治性前列腺切除术的患者中，PSAV（P=0.79）和 PSADT（P=0.87）与不良手术病理无关。
诊断后 PSA 动力学不能可靠地预测不良病理，不应用于替代每年的监测活检来监测接受主动监测的男性。
