Department of Urology, Kaohsiung Medical University Hospital, Taiwan.
Aging Male. 2012 Mar;15(1):34-41. doi: 10.3109/13685538.2011.580398. Epub 2011 May 26.
The influence of prostate-specific antigen (PSA) kinetics on the outcome of metastatic prostate cancer (PCa) after androgen-deprivation therapy (ADT) remains poorly characterised. We evaluated the prognostic significance of PSA nadir and time to PSA nadir as well as their interactive effect on prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) after ADT.
A total of 650 men with advanced or metastatic PCa treated with ADT were studied. The prognostic significance of PSA nadir and time to PSA nadir on PCSM and ACM were analysed using Kaplan-Meier analysis and the Cox regression model.
On multivariate analysis, clinical M1 stage, Gleason Score 8-10, PSA nadir ≥ 0.2 ng/ml and time to PSA nadir < 10 months were independent predictors of PCSM and ACM. The combined analysis showed that patient with higher PSA nadir and shorter time to PSA nadir had significantly higher risk of PCSM and ACM compared to those with lower PSA nadir and longer time to PSA nadir (hazard ratios = 6.30 and 4.79, respectively, all P < 0.001).
Our results suggest that higher PSA nadir level and faster time to reach PSA nadir after ADT were associated with shorter survival for PCa.
前列腺特异性抗原（PSA）动力学对去势治疗（ADT）后转移性前列腺癌（PCa）结局的影响仍未得到充分描述。我们评估了 PSA 最低点及其达到 PSA 最低点的时间对 ADT 后前列腺癌特异性死亡率（PCSM）和全因死亡率（ACM）的预后意义，以及它们之间的交互作用。
共研究了 650 例接受 ADT 治疗的晚期或转移性 PCa 男性患者。采用 Kaplan-Meier 分析和 Cox 回归模型分析 PSA 最低点和达到 PSA 最低点的时间对 PCSM 和 ACM 的预后意义。
多因素分析显示，临床 M1 期、Gleason 评分 8-10、PSA 最低点≥0.2ng/ml 和达到 PSA 最低点的时间<10 个月是 PCSM 和 ACM 的独立预测因素。联合分析显示，PSA 最低点较高且达到 PSA 最低点的时间较短的患者与 PSA 最低点较低且达到 PSA 最低点的时间较长的患者相比，PCSM 和 ACM 的风险显著更高（危险比分别为 6.30 和 4.79，均 P<0.001）。
我们的结果表明，ADT 后 PSA 最低点水平较高且达到 PSA 最低点的时间较快与 PCa 生存时间较短相关。
