Saskatchewan Cancer Agency, Regina, SK, Canada.
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):e525-30. doi: 10.1016/j.ijrobp.2012.01.041. Epub 2012 Apr 6.
It is commonly believed that prostate cancer patients with very high prostate-specific antigen (PSA) levels are unlikely to benefit from definitive local treatment, and patients with very high PSA are often underrepresented in, or excluded from, randomized clinical trials. Consequently, little is known about their optimal treatment or prognosis. We performed a registry-based analysis of management and outcome in this population of patients.
Our provincial Cancer Registry was used to identify all men who were diagnosed with prostate cancer from 1990 to 2001. A retrospective chart review provided information on stage, Gleason score, PSA at diagnosis, and treatment. In this study, ultra-high PSA was defined as PSA of ≥ 50 ng/ml. For a more complete perspective, treatment outcomes of patients with PSA of 20 to 49.9 ng/ml were also studied.
Of the 8378 men diagnosed with prostate cancer during this period, 6,449 had no known nodal or distant metastatic disease. The median follow-up of this group was 67.2 months (range, 0-192 months). A total of 1534 patients had PSA of ≥ 20 ng/ml. Among the 995 patients with PSA 20 to 49.9 ng/ml, 85 had radical prostatectomy (RP), and their 5- and 10-year cause-specific survivals (CSS) were 95% and 84%, respectively. The 497 patients treated with radiotherapy (RT) had 5- and 10-year CSS of 92% and 71%. For the 332 patients with PSA 50-99.9 ng/ml, RT was associated with 5- and 10-year CSS of 81% and 55%. For the 207 patients with PSA of ≥ 100 ng/ml, RT was associated with 5- and 10-year CSS of 80% and 54%.
This is the largest series in the world on non metastatic cancer patients with ultra-high PSA at diagnosis. Even in the setting of a very high presenting PSA level, prostatectomy and radiotherapy are often associated with prolonged survival.
人们普遍认为，前列腺特异性抗原（PSA）水平非常高的前列腺癌患者不太可能从确定性局部治疗中获益，而 PSA 水平非常高的患者往往在随机临床试验中代表性不足或被排除在外。因此，对于他们的最佳治疗方法或预后知之甚少。我们对该人群的管理和结局进行了基于登记的分析。
我们利用省级癌症登记处确定了 1990 年至 2001 年期间被诊断为前列腺癌的所有男性。回顾性病历复习提供了有关分期、Gleason 评分、诊断时 PSA 和治疗的信息。在这项研究中，超高 PSA 定义为 PSA≥50ng/ml。为了更全面地了解情况，我们还研究了 PSA 为 20 至 49.9ng/ml 的患者的治疗结果。
在这段时间内，8378 名男性被诊断患有前列腺癌，其中 6449 名患者无已知的淋巴结或远处转移疾病。该组的中位随访时间为 67.2 个月（范围 0-192 个月）。共有 1534 名患者 PSA≥20ng/ml。在 995 名 PSA 为 20 至 49.9ng/ml 的患者中，有 85 人接受了根治性前列腺切除术（RP），他们的 5 年和 10 年特异性生存（CSS）分别为 95%和 84%。497 名接受放疗（RT）治疗的患者的 5 年和 10 年 CSS 分别为 92%和 71%。对于 332 名 PSA 为 50-99.9ng/ml 的患者，RT 与 5 年和 10 年 CSS 分别为 81%和 55%相关。对于 PSA≥100ng/ml 的 207 名患者，RT 与 5 年和 10 年 CSS 分别为 80%和 54%相关。
这是世界上关于诊断时 PSA 非常高的非转移性癌症患者的最大系列研究。即使在非常高的 PSA 水平下，前列腺切除术和放疗通常也与延长生存相关。
