Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2010 Sep;184(3):925-9. doi: 10.1016/j.juro.2010.05.043.
Many patients undergoing radical prostatectomy in the prostate specific antigen era have a low risk of recurrence. Aggressive postoperative prostate specific antigen surveillance is costly and anxiety provoking. In this study we investigate the need for yearly prostate specific antigen measurements in patients with surgically treated low risk prostate cancer.
We identified 2,219 patients who underwent radical prostatectomy between 1994 and 2004 for low risk localized prostate cancer. Low risk was defined as prostate specific antigen less than 10 ng/ml, pathological stage pT2c or less, Gleason score 6 or less, negative lymph nodes and negative surgical margins. Patients who underwent neoadjuvant or adjuvant therapy were excluded from analysis. Biochemical failure was defined as a prostate specific antigen greater than 0.4 ng/ml and prostate specific antigen values less than 0.15 ng/ml were considered undetectable. Biochemical failure rates were calculated according to the duration of the prostate specific antigen-free period after radical prostatectomy.
A total of 142 (6.4%) patients experienced biochemical failure during the course of the study. The risk of biochemical failure decreased with increasing duration of the prostate specific antigen-free interval. For example 1, 3 and 5-year biochemical failure rates calculated at surgery were 1.8%, 4.2% and 6.3%, respectively. For patients with undetectable prostate specific antigen measurements 5 years after surgery the 1, 3 and 5-year biochemical failure rates were 0.0%, 0.7% and 1.3%, respectively. In addition, 1-year biochemical failure rates were 0.2%, 0.4%, 0.0% and 0.0% after a prostate specific antigen-free period of 1, 3, 5 and 10 years, respectively.
The risk of biochemical failure is inversely proportional to the duration of the prostate specific antigen-free interval after radical prostatectomy in low risk patients. Biochemical failure 1 year after an undetectable prostate specific antigen is uncommon, especially after a prostate specific antigen-free period of 3 years. These data suggest that annual prostate specific antigen measurements are unnecessary, especially after a prostate specific antigen-free interval of 3 years. Prostate specific antigen measurements every 2 years should capture the majority of low risk patients who experience progression.
在 PSA 时代，许多接受根治性前列腺切除术的患者复发风险较低。术后积极进行 PSA 监测既昂贵又令人焦虑。在这项研究中，我们探讨了对接受低危前列腺癌手术治疗的患者进行每年 PSA 检测的必要性。
我们确定了 2219 名 1994 年至 2004 年期间接受根治性前列腺切除术治疗低危局限性前列腺癌的患者。低危定义为 PSA＜10ng/ml，病理分期 pT2c 或更低，Gleason 评分≤6，淋巴结阴性，切缘阴性。排除接受新辅助或辅助治疗的患者。生化失败定义为 PSA＞0.4ng/ml，PSA＜0.15ng/ml 被认为是无法检测到的。根据根治性前列腺切除术后 PSA 无复发生存期的长短计算生化失败率。
在研究过程中，共有 142 名（6.4%）患者发生生化失败。随着 PSA 无复发生存期的延长，生化失败的风险降低。例如，手术时计算的 1、3 和 5 年生化失败率分别为 1.8%、4.2%和 6.3%。对于术后 PSA 检测值不可检测 5 年的患者，1、3 和 5 年的生化失败率分别为 0.0%、0.7%和 1.3%。此外，PSA 无复发生存期分别为 1、3、5 和 10 年时，1 年生化失败率分别为 0.2%、0.4%、0.0%和 0.0%。
在低危患者中，根治性前列腺切除术后 PSA 无复发生存期与生化失败风险呈反比。PSA 检测值不可检测 1 年后生化失败并不常见，尤其是 PSA 无复发生存期为 3 年以后。这些数据表明，每年进行 PSA 检测是不必要的，尤其是 PSA 无复发生存期为 3 年以后。每 2 年进行 PSA 检测应能捕获大多数经历进展的低危患者。
