Abu-Hamar Abd El Halim M, Gameel Tarek A
The Departments of Clinical Oncology, Faculty of Medicine, Tanta University, Egypt.
J Egypt Natl Canc Inst. 2009 Sep;21(3):229-36.
The aim of this study was to evaluate the prognostic significance of each of the following in the development and progression of hormonal refractory disease in patients with metastatic prostate cancer under hormonal palliative treatment: The initial serum level prostate specific antigen (PSA), the Gleason score (GS), the presence of bone metastases with or without visceral metastases, and the PSA decline.
During the time period from January 2005 to December 2008, a total of 92 patients with newly diagnosed, histologically confirmed metastatic prostate cancer (MPC) were under palliative androgen deprivation therapy. The age range was 52 to 85 years with a mean age of 66.2±7.9 years. MPC was diagnosed histologically after transrectal ultrasonography guided biopsy. The Gleason score assessment was determined by low power microscopic examination. Metastases were confirmed by positive bone scintigraphy with 925 MBq 99mTc-MDP using a tomographic gamma camera, computerized axial tomography or magnetic resonance imagining. Measurements of PSA levels were conducted by the radioimmunoassay method. The influences of the following prognostic factors were evaluated: The initial serum level of prostate specific antigen (PSA), the Gleason score (GS), the presence of bone metastases with or without visceral metastases, and the PSA decline, on the time to disease progression.
The time to progression was significantly delayed in patients with initial PSA level $50ng/ml (median: 32 months), Gleason Score $7 (median: 33 months), bone metastases only (median: 30 months) and PSA level normalization within 6 months (median: 30 months) compared to that of patients with initial PSA level >50ng/ml (median: 24 months), Gleason Score >7 (median: 24 months), bone, distant lymph nodes and/or visceral metastases (median: 24 months), PSA level decline (median: 18 months) (p-values were 0.002, <0.001, <0.001 and <0.001 respectively). The time to progression was not significantly delayed in patients with $6 sites bone metastases (median: 30 months) compared to that of patients with >6 sites bone metastases (median: 28 months) (p=0.122).
Our results showed that the initial PSA level, the Gleason score, the presence of bone, lymph nodes and visceral metastases, and the PSA level decline could predict increased risk of disease progression in patients with metastatic prostate cancer.
Prostatic specific antigen - Gleason score - Bone scan - Androgen deprivation therapy.
本研究旨在评估以下各项因素在接受姑息性激素治疗的转移性前列腺癌患者激素难治性疾病发生和进展中的预后意义：初始血清前列腺特异性抗原（PSA）水平、 Gleason评分（GS）、有无内脏转移的骨转移情况以及PSA下降情况。
在2005年1月至2008年12月期间，共有92例新诊断、经组织学确诊的转移性前列腺癌（MPC）患者接受了姑息性雄激素剥夺治疗。年龄范围为52至85岁，平均年龄为66.2±7.9岁。经直肠超声引导下活检后通过组织学确诊MPC。Gleason评分评估通过低倍显微镜检查确定。通过使用断层γ相机、计算机断层扫描或磁共振成像的925 MBq 99mTc-MDP骨闪烁显像阳性来确认转移情况。采用放射免疫分析法测定PSA水平。评估以下预后因素对疾病进展时间的影响：初始血清前列腺特异性抗原（PSA）水平、 Gleason评分（GS）、有无内脏转移的骨转移情况以及PSA下降情况。
与初始PSA水平>50 ng/ml（中位数：24个月）、Gleason评分>7（中位数：24个月）、骨、远处淋巴结和/或内脏转移（中位数：24个月）、PSA水平下降（中位数：18个月）的患者相比，初始PSA水平≤50 ng/ml（中位数：32个月）、Gleason评分≤7（中位数：33个月）、仅骨转移（中位数：30个月）且6个月内PSA水平正常化（中位数：30个月）的患者疾病进展时间显著延迟（p值分别为0.002、<0.001、<0.001和<0.001）。与骨转移部位>6个（中位数：28个月）的患者相比，骨转移部位≤6个（中位数：30个月）的患者疾病进展时间未显著延迟（p = 0.122）。
我们的结果表明，初始PSA水平、Gleason评分、骨、淋巴结和内脏转移情况以及PSA水平下降可预测转移性前列腺癌患者疾病进展风险增加。
前列腺特异性抗原 - Gleason评分 - 骨扫描 - 雄激素剥夺治疗
