雄激素剥夺治疗期间可检测到的前列腺特异性抗原 nadir 可预测不良的前列腺癌特异性结局：来自 SEARCH 数据库的结果。
Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database.
机构信息
Duke University School of Medicine, Durham, NC, USA; Veterans Affairs Medical Center, Durham, NC, USA.
University of California at Los Angeles Medical Center, Los Angeles, CA, USA; Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA, USA.
出版信息
Eur Urol. 2014 Mar;65(3):620-7. doi: 10.1016/j.eururo.2012.11.052. Epub 2012 Dec 6.
BACKGROUND
A prostate-specific antigen (PSA) level <0.2 ng/ml 8 mo after starting on androgen-deprivation therapy (ADT) is correlated with better outcomes. However, not all men reach a nadir PSA level within 8 mo. Whether the lowest PSA on ADT-specifically, <0.2 ng/ml-can be used for risk stratification is untested.
OBJECTIVE
We examined the predictive value of small but detectable PSA nadir values on prostate cancer (PCa)-specific outcomes in men treated with early ADT after radical prostatectomy (RP).
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA nadir was 49 mo. All men had a PSA nadir <4 ng/ml; 223 men (76%) had an undetectable nadir.
INTERVENTION
ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
PSA nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA nadir and PCa-specific outcomes.
RESULTS AND LIMITATIONS
Men with a PSA nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p<0.001), metastases (HR: 3.98; p=0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p=0.003) than men with an undetectable nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively.
CONCLUSIONS
A PSA nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA nadir during ADT should be considered for clinical trials.
背景
开始雄激素剥夺治疗（ADT）8 个月后前列腺特异性抗原（PSA）水平<0.2ng/ml 与更好的结局相关。然而，并非所有男性都能在 8 个月内达到 PSA 最低值。在 ADT 时 PSA 最低值是否可用于风险分层尚待检验，特别是是否可用于<0.2ng/ml。
目的
我们检测了 PSA 最低值很小但可检测到的情况下，对接受根治性前列腺切除术（RP）后早期 ADT 治疗的男性前列腺癌（PCa）特异性结局的预测价值。
设计、设置和参与者：我们对 SEARCH 数据库中接受 RP 后 ADT 治疗的男性进行了回顾性分析。我们共纳入 402 例接受 ADT 治疗以降低 PSA 水平的 RP 后男性，其中 294 例男性有完整的数据。PSA 最低值后中位随访时间为 49 个月。所有男性 PSA 最低值<4ng/ml，223 例男性（76%）的 PSA 最低值不可检测。
干预
RP 后因 PSA 升高而接受 ADT，且无影像学证据显示有转移疾病。
观察指标和统计分析
ADT 时 PSA 最低值定义为 ADT 期间的最低 PSA 值。比例风险模型和 C 指数分别用于检测 PSA 最低值与 PCa 特异性结局之间的关联和预测准确性。
结果和局限性
PSA 最低值在 0.01-0.2ng/ml 之间的男性进展为去势抵抗性 PCa（CRPC）（风险比[HR]：5.14；p<0.001）、转移（HR：3.98；p=0.006）和 PCa 特异性死亡率（PCSM）（HR：5.33；p=0.003）的风险高于 PSA 最低值不可检测的男性。当数据仅限于接受超敏 PSA 值随访的男性（检测灵敏度为 0.01ng/ml）时，PSA 最低值单独预测 CRPC、转移和 PCSM 的 C 指数分别为 0.88、0.91 和 0.96。
结论
ADT 时 PSA 最低值，即使处于非常低的水平，也强烈预示着进展为 CRPC、转移和 PCSM。ADT 时 PSA 最低值可检测到的男性应考虑参加临床试验。
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