Hudson M A, Bahnson R R, Catalona W J
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
J Urol. 1989 Oct;142(4):1011-7. doi: 10.1016/s0022-5347(17)38972-3.
The clinical use of prostate specific antigen as a screening test for prostate cancer, as a preoperative determinant for staging of prostate cancer and to monitor response to therapy in prostatic cancer patients was evaluated in 168 men with benign prostatic hyperplasia and 231 men with prostate cancer. Only 3% of the men with benign prostatic hyperplasia had prostate specific antigen levels greater than 10 ng. per ml. compared to 44% of the men with proved prostate cancer. Preoperative prostate specific antigen levels increased with higher clinical stages of prostate cancer but there was substantial overlap among stages. Among patients with stage A1 prostate cancer who were followed expectantly none had an elevated prostate specific antigen value or metastatic disease during a followup of 15 to 120 months. After radical prostatectomy serum prostate specific antigen values decreased to undetectable levels (less than 0.6 ng. per ml.) in 89% of the patients with organ-confined disease, in 87% of those with microscopically positive margins only but in only 34% with seminal vesicles or lymph node involvement. Failure of the prostate specific antigen levels to decrease to the undetectable range after radical prostatectomy was associated with a greater likelihood of subsequent tumor recurrence. Only 3 of 18 patients (17%) treated with definitive radiation therapy had post-irradiation prostate specific antigen values of less than 0.6 ng. per ml., while in 39% the prostate specific antigens values remained greater than 4 ng. per ml. and in 4 of 18 (22%) the values were greater than 10 ng. per ml. Of patients with previously untreated stage D2 prostate cancer the mean pre-treatment prostate specific antigen value was 63.7 ng. per ml. compared to a post-hormonal therapy mean value of 31.1 ng. per ml. Of 32 patients treated with hormonal therapy 14 had stable disease, including 13 with prostate specific antigen levels of less than 10 ng. per ml. In contrast, 18 patients had progressive disease, of whom 16 had prostate specific antigen levels of more than 10 ng. per ml. We conclude that the serum prostate specific antigen assay is most useful clinically to monitor the response to therapy of prostate cancer patients.
对168例良性前列腺增生男性患者和231例前列腺癌男性患者评估了前列腺特异性抗原作为前列腺癌筛查试验、前列腺癌术前分期决定因素以及监测前列腺癌患者治疗反应的临床应用。仅3%的良性前列腺增生男性患者前列腺特异性抗原水平高于10 ng/ml，相比之下，确诊前列腺癌的男性患者中有44%高于此值。术前前列腺特异性抗原水平随前列腺癌临床分期升高而增加，但各分期之间有大量重叠。在接受观察等待的A1期前列腺癌患者中，在15至120个月的随访期间，无人前列腺特异性抗原值升高或发生转移。根治性前列腺切除术后，89%的局限性疾病患者、87%仅显微镜下切缘阳性的患者血清前列腺特异性抗原值降至无法检测水平（低于0.6 ng/ml），但精囊或淋巴结受累的患者中只有34%降至该水平。根治性前列腺切除术后前列腺特异性抗原水平未降至无法检测范围与随后肿瘤复发的可能性更大相关。接受确定性放射治疗的18例患者中只有3例（17%）放疗后前列腺特异性抗原值低于0.6 ng/ml，而39%的患者前列腺特异性抗原值仍高于4 ng/ml，18例中有4例（22%）高于10 ng/ml。在先前未经治疗的D2期前列腺癌患者中，治疗前前列腺特异性抗原平均水平为63.7 ng/ml，激素治疗后平均水平为31.1 ng/ml。在接受激素治疗的32例患者中，14例病情稳定，其中13例前列腺特异性抗原水平低于10 ng/ml。相比之下，18例患者病情进展，其中16例前列腺特异性抗原水平高于10 ng/ml。我们得出结论，血清前列腺特异性抗原检测在临床上对监测前列腺癌患者的治疗反应最有用。
