Discipline of Medicine, University of Adelaide, SA, Australia.
Radiother Oncol. 2013 May;107(2):129-33. doi: 10.1016/j.radonc.2013.03.030. Epub 2013 Apr 23.
To assess the association between PSA velocity (PSAV) in the first 24 months after external beam radiotherapy (EBRT) and prostate cancer-specific mortality (PCSM) and all cause mortality.
All eligible patients in the South Australian (SA) Prostate Cancer Clinical Outcomes registry were followed. 848 Patients treated by definitive EBRT with more than one PSA recorded in the two year post-treatment were included. We calculated PSAV by linear regression.
The mean number of PSA measurements in the 2year period was 4.4 (SD1.9). The median PSAVs across quartiles (Q1-Q4) were -4.17, -1.29, -0.38 and 0.20ng/ml/yr. In multivariable analysis, a U-shaped relationship was seen between PSAV and PCSM with Q1-Q4 hazard ratios (HR) being 3.82 (1.46-10.00), 3.07 (1.10-8.58), 1, 5.15 (1.99-13.30) respectively. HR for all cause mortality in a similar model were 1.79 (1.07-2.98), 1.55 (0.93-2.59), 1.00 and 1.74 (1.04-2.90) for Q1 to Q4 respectively. A rapid PSA decline in the first year was a strong predictor of PCSM. However, in the second year PSA increase was positively associated with PCSM.
A rapid decline in PSA in the first year following EBRT is positively associated with PCSM. This may be a useful early indicator of the need for additional therapies.
评估外照射放疗（EBRT）后 24 个月内 PSA 速度（PSAV）与前列腺癌特异性死亡率（PCSM）和全因死亡率之间的关系。
对南澳大利亚（SA）前列腺癌临床结局登记处的所有符合条件的患者进行随访。共纳入 848 例接受根治性 EBRT 治疗且在治疗后 2 年内有多个 PSA 记录的患者。我们通过线性回归计算 PSAV。
在 2 年期间，PSA 测量的平均次数为 4.4（SD1.9）。四分位数（Q1-Q4）的中位 PSAV 分别为-4.17、-1.29、-0.38 和 0.20ng/ml/yr。在多变量分析中，PSAV 与 PCSM 之间呈 U 型关系，Q1-Q4 的风险比（HR）分别为 3.82（1.46-10.00）、3.07（1.10-8.58）、1、5.15（1.99-13.30）。在类似模型中，全因死亡率的 HR 分别为 1.79（1.07-2.98）、1.55（0.93-2.59）、1.00 和 1.74（1.04-2.90），分别对应 Q1 到 Q4。EBRT 后第一年 PSA 快速下降是 PCSM 的强烈预测因子。然而，第二年 PSA 升高与 PCSM 呈正相关。
EBRT 后第一年 PSA 快速下降与 PCSM 呈正相关。这可能是需要额外治疗的早期有用指标。
