Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94115, USA.
J Urol. 2011 Dec;186(6):2228-32. doi: 10.1016/j.juro.2011.07.119. Epub 2011 Oct 19.
In men with biochemical recurrence after radical prostatectomy, a rapid prostate specific antigen doubling time is associated with adverse outcomes, and is often used to guide the type and timing of salvage therapy. It is unknown whether prostate specific antigen doubling time calculated in the ultrasensitive range (prostate specific antigen less than 0.2 ng/ml) accurately reflects measures performed in the traditional range (prostate specific antigen greater than 0.2 ng/ml).
We studied 394 men in a national disease registry of men with prostate cancer (CaPSURE™) who underwent radical prostatectomy, experienced biochemical failure, and had prostate specific antigen doubling time assessed using ultrasensitive and traditional prostate specific antigen values. Agreement between these measurements was assessed using Cohen's kappa score.
Median ultrasensitive prostate specific antigen doubling time was 11.9 months (IQR 6-29) and median traditional prostate specific antigen doubling time was 240 months (IQR 18-240). Agreement between ultrasensitive and traditional prostate specific antigen doubling time was poor, with a weighted Cohen's kappa score of 0.04 (95% CI -0.02-0.10). Using a dichotomous prostate specific antigen doubling time cutoff of 9 months, there was a statistically significant difference between ultrasensitive and standard prostate specific antigen doubling time (exact McNemar p <0.01). Ultrasensitive prostate specific antigen doubling time was more or less rapid than traditional prostate specific antigen doubling time by more than 15 months in 244 (62%) and 35 (9%) patients, respectively.
Agreement between prostate specific antigen doubling time calculated using ultrasensitive vs traditional prostate specific antigen values is poor. Ultrasensitive prostate specific antigen doubling time is often significantly more rapid than traditional prostate specific antigen doubling time, potentially overestimating the risk of clinical recurrence. Until the significance of ultrasensitive prostate specific antigen doubling time is better characterized, the decision to proceed with salvage therapy should not be based on prostate specific antigen doubling time calculated using ultrasensitive prostate specific antigen values.
在接受根治性前列腺切除术的生化复发男性中，前列腺特异性抗原倍增时间较快与不良结局相关，常被用于指导挽救性治疗的类型和时机。目前尚不清楚在超敏范围内（前列腺特异性抗原<0.2ng/ml）计算的前列腺特异性抗原倍增时间是否准确反映了在传统范围内（前列腺特异性抗原>0.2ng/ml）进行的测量。
我们研究了全国前列腺癌登记处（CaPSURE）中 394 名接受根治性前列腺切除术、发生生化失败且采用超敏和传统前列腺特异性抗原值评估前列腺特异性抗原倍增时间的男性。使用 Cohen's kappa 评分评估这些测量值之间的一致性。
中位超敏前列腺特异性抗原倍增时间为 11.9 个月（IQR，6-29），中位传统前列腺特异性抗原倍增时间为 240 个月（IQR，18-240）。超敏和传统前列腺特异性抗原倍增时间之间的一致性较差，加权 Cohen's kappa 评分 0.04（95%CI-0.02-0.10）。使用 9 个月的前列腺特异性抗原倍增时间二分位数截断值，超敏前列腺特异性抗原倍增时间和标准前列腺特异性抗原倍增时间之间存在统计学显著差异（确切 McNemar p<0.01）。分别有 244 例（62%）和 35 例（9%）患者的超敏前列腺特异性抗原倍增时间比传统前列腺特异性抗原倍增时间快或慢超过 15 个月。
使用超敏和传统前列腺特异性抗原值计算的前列腺特异性抗原倍增时间之间的一致性较差。超敏前列腺特异性抗原倍增时间通常明显快于传统前列腺特异性抗原倍增时间，可能高估了临床复发的风险。在更好地确定超敏前列腺特异性抗原倍增时间的意义之前，不应基于超敏前列腺特异性抗原值计算的前列腺特异性抗原倍增时间来决定是否进行挽救性治疗。
