Arizona Cancer, Tucson, Arizona, USA.
Intern Med J. 2012 Apr;42(4):374-80. doi: 10.1111/j.1445-5994.2011.02473.x.
Current diagnostic tools are inadequate for reliable prediction of prostate cancer (PCa) aggressiveness in patients with localised disease. This results in many patients being exposed to potentially unnecessary invasive treatment and its associated morbidities. In order to develop appropriate treatment strategies, it is essential to understand the differences between patients who will develop aggressive disease and those who will not.
A longitudinal study was conducted in men with localised PCa on active surveillance for their disease in which 140 subjects were followed every 3 months for up to 5 years. Change in prostate-specific antigen (PSA) over time (PSA velocity) was used as a marker for PCa progression. Subjects were categorised as slow, intermediate and fast progressors based on tertiles of PSA velocity. Differences in baseline markers were investigated using logistic regressions. Two approaches were used, slow progressors were compared with fast progressors (model 1) and slow progressors were compared with combination of intermediate and fast progressors (model 2).
Aspirin was negatively associated with high PSA velocity in model 1 (odds ratio (95% confidence interval): 0.24 (0.06, 0.94), P-value = 0.04) and model 2 (odds ratio = 0.22 (0.08, 0.59), P-value = 0.003), whereas smoking was positively associated with high PSA velocity in model 1 (1.03 (0.92, 1.13), P-value = 0.01).
These findings highlight the role of aspirin and smoking in PCa progression. They have potential towards risk stratification as well as PCa prevention and hence need to be investigated further.
目前的诊断工具不足以可靠地预测局部前列腺癌（PCa）患者的侵袭性。这导致许多患者接受潜在的不必要的侵入性治疗及其相关的发病率。为了制定适当的治疗策略，了解哪些患者会发展为侵袭性疾病，哪些患者不会发展为侵袭性疾病至关重要。
对接受主动监测的局部 PCa 男性进行了一项纵向研究，其中 140 名患者每 3 个月随访一次，最长随访 5 年。前列腺特异性抗原（PSA）随时间的变化（PSA 速度）被用作 PCa 进展的标志物。根据 PSA 速度的三分位数，将患者分为缓慢、中度和快速进展者。使用逻辑回归分析了基线标志物的差异。使用了两种方法，缓慢进展者与快速进展者进行比较（模型 1），以及缓慢进展者与中速和快速进展者的组合进行比较（模型 2）。
在模型 1 中，阿司匹林与高 PSA 速度呈负相关（优势比（95%置信区间）：0.24（0.06，0.94），P 值=0.04）和模型 2（优势比=0.22（0.08，0.59），P 值=0.003），而吸烟与高 PSA 速度呈正相关在模型 1 中（1.03（0.92，1.13），P 值=0.01）。
这些发现强调了阿司匹林和吸烟在 PCa 进展中的作用。它们有可能用于风险分层以及 PCa 的预防，因此需要进一步研究。
