Uchio Edward M, Aslan Mihaela, Wells Carolyn K, Calderone Juan, Concato John
Surgical Urology and Medical Service, VA Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, 151B, West Haven, CT 06516, USA.
Arch Intern Med. 2010 Aug 9;170(15):1390-5. doi: 10.1001/archinternmed.2010.262.
Among men treated for prostate cancer, increasing prostate-specific antigen (PSA) is known as biochemical failure or biochemical recurrence (BCR). The impact of BCR on subsequent mortality is uncertain, however, especially given competing causes of death.
To describe patterns of BCR and subsequent mortality, we conducted an observational study in a community-based, "high-comorbidity" setting of 623 US veterans diagnosed as having prostate cancer from 1991 to 1995 and receiving radical prostatectomy or radiation therapy. The main outcome measures were BCR, defined as a PSA level of 0.4 ng/mL or higher (treated with surgery) or "PSA nadir+2 ng/mL" (treated with radiation therapy), and prostate cancer mortality, determined through 2006.
With 5-, 10-, and 15-year follow-up periods, respectively (for all results shown herein), the cumulative incidence of BCR after prostatectomy (n=225) was 34%, 37%, and 37%; prostate cancer mortality among men who failed treatment (n=81) was 3%, 11%, and 21%. Among men receiving radiation therapy (n=398), the cumulative incidence of BCR was 35%, 46%, and 48%; prostate cancer mortality among those who failed treatment (n=161) was 11%, 20%, and 42%. Overall, BCR was associated with an increased risk of death from prostate cancer in the study population, but the individual probability of this outcome was relatively low.
Biochemical recurrence is associated with increased prostate cancer mortality, yet when BCR occurs only a minority of men subsequently die of their disease. The phrase "most men die with prostate cancer, not of it" applies to elderly veterans, even after failure of primary treatment. New strategies for defining and managing treatment failure in prostate cancer are needed.
在接受前列腺癌治疗的男性中，前列腺特异性抗原（PSA）升高被称为生化失败或生化复发（BCR）。然而，BCR对后续死亡率的影响尚不确定，尤其是考虑到存在其他死亡原因。
为了描述BCR模式及后续死亡率，我们在一个以社区为基础的“高合并症”环境中进行了一项观察性研究，研究对象为1991年至1995年被诊断患有前列腺癌并接受根治性前列腺切除术或放射治疗的623名美国退伍军人。主要结局指标为BCR（定义为PSA水平达到0.4 ng/mL或更高（接受手术治疗者）或“PSA最低点+2 ng/mL”（接受放射治疗者））以及前列腺癌死亡率（截至2006年确定）。
分别进行5年、10年和15年随访（此处展示的所有结果）后，前列腺切除术后（n = 225）BCR的累积发生率分别为34%、37%和37%；治疗失败男性（n = 81）中的前列腺癌死亡率分别为3%、11%和21%。在接受放射治疗的男性（n = 398）中，BCR的累积发生率分别为35%、46%和48%；治疗失败男性（n = 161）中的前列腺癌死亡率分别为11%、20%和42%。总体而言，BCR与研究人群中前列腺癌死亡风险增加相关，但这一结局的个体概率相对较低。
生化复发与前列腺癌死亡率增加相关，但当BCR发生时，只有少数男性随后死于该疾病。“大多数男性死于前列腺癌相关疾病，而非死于前列腺癌本身”这句话适用于老年退伍军人，即使在初始治疗失败后也是如此。需要制定新的策略来定义和管理前列腺癌治疗失败。
