Xia Jing, Trock Bruce J, Gulati Roman, Mallinger Leslie, Cooperberg Matthew R, Carroll Peter R, Carter H Ballentine, Etzioni Ruth
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clin Cancer Res. 2014 Oct 15;20(20):5302-10. doi: 10.1158/1078-0432.CCR-13-3366.
Prostate-specific antigen recurrence (PSA-R) after radical prostatectomy (RP) can occur years before metastasis. This study estimates the chance that an untreated PSA-R would not progress to clinical metastasis within the patient's lifetime, that is, that recurrence is overdetected.
Times from PSA-R to metastasis were estimated from patients with RP treated at Johns Hopkins University (Baltimore, MD) who did not receive salvage treatment (n = 441) at PSA-R. Times to other-cause death were based on U.S. life tables adjusted to reflect other-cause survival among RP cases in the Surveillance, Epidemiology, and End Results (SEER) registry. We used competing risks simulation to estimate lower bounds on the chance that other-cause death would precede clinical metastasis for patients with disease characteristics at diagnosis based on the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database (n = 4,455).
Cumulative incidence of PSA-R in CaPSURE was 13.6% at 5 years and 19.9% at 10 years. The risk of other-cause death among patients with RP in SEER was 60% lower than the age-matched U.S. population. At least 9.1% of patients with PSA-R <5 years after RP and at least 15.6% of patients with PSA-R 5 to 10 years after RP were overdetected. At least 31.4% of patients over the age of 70 years at diagnosis, who recurred <10 years of diagnosis, were overdetected.
This analysis indicates that PSA-R after RP may be overdetected, with risk depending on patient age and tumor characteristics. The potential for overdetection of recurrence confirms the need for approaches to determine whether and when to initiate salvage therapies.
根治性前列腺切除术后（RP）前列腺特异性抗原复发（PSA-R）可能在转移前数年出现。本研究估计了未经治疗的PSA-R在患者生存期内不会进展为临床转移的概率，即复发被过度检测。
从约翰霍普金斯大学（马里兰州巴尔的摩）接受RP治疗且在PSA-R时未接受挽救性治疗的患者（n=441）中估计从PSA-R到转移的时间。其他原因导致死亡的时间基于根据监测、流行病学和最终结果（SEER）登记处中RP病例的其他原因生存率进行调整的美国生命表。我们使用竞争风险模拟来估计基于前列腺癌战略泌尿外科研究计划（CaPSURE）数据库（n=4455）中诊断时疾病特征的患者因其他原因死亡先于临床转移的概率下限。
CaPSURE中PSA-R的累积发生率在5年时为13.6%，在10年时为19.9%。SEER中RP患者因其他原因死亡的风险比年龄匹配的美国人群低60%。RP后PSA-R<5年的患者中至少9.1%以及RP后PSA-R为5至10年的患者中至少15.6%被过度检测。诊断时年龄超过70岁且在诊断后<10年复发的患者中至少31.4%被过度检测。
该分析表明RP后的PSA-R可能被过度检测，风险取决于患者年龄和肿瘤特征。复发过度检测的可能性证实了需要有方法来确定是否以及何时开始挽救性治疗。
