Department of Urology, University Of Turin, Torino, Italy.
BJU Int. 2011 Oct;108(7):1093-100. doi: 10.1111/j.1464-410X.2011.10076.x. Epub 2011 Mar 10.
• To assess the feasibility of radical prostatectomy (RP) in a series of patients with prostate cancer with very high prostate-specific antigen (PSA) levels by comparing the clinical outcomes of different PSA thresholds (20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL, respectively).
• Within a multicentre European retrospective database of 712 RP in patients with a baseline PSA level >20 ng/mL, we identified 48 patients with prostate cancer with a preoperative PSA level >100 ng/mL, 137 with a PSA level between 50.1 and 100 ng/mL and 527 with PSA values between 20.1 and 50 ng/mL. • Comparisons between groups were performed using chi-square test, analysis of variance and Kaplan-Meier analysis with log-rank test.
• Ten-year projected cancer-specific survival (79.8% in the PSA >100 ng/mL group vs 85.4% in the PSA 50.1-99 ng/mL group vs 90.9% in the PSA 20.1-50 ng/mL interval; P = 0.037) but not overall survival (59.6% in the PSA >100 ng/mL group vs 71.8% in the PSA 50.1-99 ng/mL group vs 75.3% in the PSA 20.1-50 ng/mL interval; P = 0.087) appeared significantly affected by the different PSA thresholds. • At a median follow-up of 78.7 months, 25.8%, 6.6% and 8.3% of patients in the PSA level groups for 20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL respectively, were cured by surgery alone.
• Ten-year cancer-specific survival, while showing significant reduction with increasing PSA values intervals, remain relatively high even for PSA levels >100 ng/mL. • As part of a multimodal treatment strategy, RP may therefore be an option, even in selected patients with prostate cancer whose PSA level is >100 ng/mL.
通过比较不同 PSA 阈值（分别为 20.1-50ng/mL、50.1-100ng/mL 和>100ng/mL）下的临床结局，评估前列腺癌患者极高 PSA 水平下接受根治性前列腺切除术（RP）的可行性。
在一项包含 712 例基线 PSA 水平>20ng/mL 的患者的多中心欧洲回顾性数据库中，我们确定了 48 例术前 PSA 水平>100ng/mL、137 例 PSA 水平在 50.1-100ng/mL 之间和 527 例 PSA 值在 20.1-50ng/mL 之间的前列腺癌患者。使用卡方检验、方差分析和 Kaplan-Meier 分析进行组间比较，采用对数秩检验。
10 年预测癌症特异性生存率（PSA>100ng/mL 组为 79.8%，PSA 50.1-99ng/mL 组为 85.4%，PSA 20.1-50ng/mL 组为 90.9%；P=0.037），而不是总体生存率（PSA>100ng/mL 组为 59.6%，PSA 50.1-99ng/mL 组为 71.8%，PSA 20.1-50ng/mL 组为 75.3%；P=0.087）明显受到不同 PSA 阈值的影响。在中位随访 78.7 个月时，PSA 水平在 20.1-50ng/mL、50.1-100ng/mL 和>100ng/mL 组的患者中，分别有 25.8%、6.6%和 8.3%单独接受手术治愈。
尽管随着 PSA 值区间的增加，10 年癌症特异性生存率显著降低，但即使 PSA 水平>100ng/mL，生存率仍然相对较高。作为多模式治疗策略的一部分，RP 可能是一种选择，即使对于 PSA 水平>100ng/mL 的选定前列腺癌患者也是如此。
