血清前列腺特异性抗原值高于100 ng/ml的男性发生远处转移的风险及癌症特异性生存率

The Risk of Distant Metastases and Cancer Specific Survival in Men with Serum Prostate Specific Antigen Values above 100 ng/ml.

作者信息

Stattin Karl, Sandin Fredrik, Bratt Ola, Lambe Mats

机构信息

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden.

出版信息

J Urol. 2015 Dec;194(6):1594-600. doi: 10.1016/j.juro.2015.07.082. Epub 2015 Jul 17.

DOI:10.1016/j.juro.2015.07.082

PMID:26192253

Abstract

PURPOSE

Current EAU (European Association of Urology) guidelines state that prostate specific antigen 100 ng/ml or greater at diagnosis indicates metastatic disease. We examined the association of prostate specific antigen 100 ng/ml or greater at diagnosis with distant metastasis and prostate cancer specific survival.

MATERIAL AND METHODS

A total of 15,635 men with prostate cancer diagnosed between 1998 and 2009 who were identified in PCBaSe (Prostate Cancer Data Base Sweden 2.0) were included in a population based registry study. Prostate cancer specific survival was compared among 3 groups, including 1,879 men with prostate specific antigen 100 ng/ml or greater and negative imaging (M0), 5,642 with distant metastases on imaging (M1) and prostate specific antigen 100 ng/ml or greater, and 3,828 with M1 and prostate specific antigen less than 100 ng/ml. A fourth group consisted of 4,286 men with prostate specific antigen 100 ng/ml or greater who had not undergone imaging (Mx). The latter men were not included in the assessment of survival.

RESULTS

Of 7,521 men with prostate specific antigen 100 ng/ml or greater who underwent imaging for staging 75% were classified with M1 disease. Only 59% of 3,527 men with prostate specific antigen 100 to 300 mg/ml had distant metastases on imaging. Five-year prostate cancer specific survival was 72% (95% CI 70-74) in men with prostate specific antigen 100 ng/ml or greater and M0, 24% (95% CI 23-25) in men with prostate specific antigen 100 ng/ml or greater and M1, and 39% (95% CI 37-40) in men with prostate specific antigen less than 100 ng/ml and M1.

CONCLUSIONS

A fourth of men with prostate specific antigen 100 ng/ml or greater did not have distant metastases. They had twofold to threefold higher 5-year survival than men with distant metastases on imaging. Our findings strongly suggest that using prostate specific antigen 100 ng/ml or greater as an indicator of metastatic disease should be reconsidered.

摘要

目的

欧洲泌尿外科学会（EAU）当前的指南指出，诊断时前列腺特异性抗原（PSA）≥100 ng/ml提示存在转移性疾病。我们研究了诊断时PSA≥100 ng/ml与远处转移及前列腺癌特异性生存之间的关联。

材料与方法

一项基于人群的登记研究纳入了1998年至2009年间在前列腺癌数据库瑞典版2.0（PCBaSe）中确诊的15635例前列腺癌男性患者。比较了3组患者的前列腺癌特异性生存情况，包括1879例PSA≥100 ng/ml且影像学检查阴性（M0）的患者、5642例影像学检查有远处转移（M1）且PSA≥100 ng/ml的患者以及3828例M1且PSA＜100 ng/ml的患者。第四组由4286例未接受影像学检查（Mx）且PSA≥100 ng/ml的男性患者组成。后一组患者未纳入生存评估。

结果

在7521例PSA≥100 ng/ml且接受分期影像学检查的男性患者中，75%被归类为M1期疾病。在3527例PSA为100至300 ng/ml的男性患者中，只有59%在影像学检查中有远处转移。PSA≥100 ng/ml且M0的男性患者5年前列腺癌特异性生存率为72%（95%CI 70 - 74），PSA≥100 ng/ml且M1的男性患者为24%（95%CI 23 - 25），PSA＜100 ng/ml且M1的男性患者为39%（95%CI 37 - 40）。