Yu Jiwoong, Kwon Young Suk, Kim Sinae, Han Christopher Sejong, Farber Nicholas, Kim Jongmyung, Byun Seok Soo, Kim Wun-Jae, Jeon Seong Soo, Kim Isaac Yi
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick.
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick; Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey.
J Urol. 2016 May;195(5):1464-1470. doi: 10.1016/j.juro.2015.11.031. Epub 2015 Dec 1.
Active surveillance is now the treatment of choice in men with low risk prostate cancer. Although there is no consensus on which patients are eligible for active surveillance, prostate specific antigen above 10 ng/ml is generally excluded. In an attempt to determine the validity of using a prostate specific antigen cutoff of 10 ng/ml to counsel men considering active surveillance we analyzed a multi-institution database to determine the pathological outcome in men with prostate specific antigen greater than 10 ng/ml but histologically favorable risk prostate cancer.
We queried a prospectively maintained database of men with histologically favorable risk prostate cancer who underwent radical prostatectomy between 2003 and 2015. The cohort was categorized into 3 groups based on prostate specific antigen level, including low-less than 10 ng/ml, intermediate-10 or greater to less than 20 and high-20 or greater. Associations of prostate specific antigen group with adverse pathological and oncologic outcomes were analyzed.
Of 2,125 patients 1,327 were categorized with histologically favorable risk disease. However on multivariate analyses the rates of up staging and upgrading were similar between the intermediate and low prostate specific antigen groups. In contrast compared to the intermediate prostate specific antigen group the high group had higher incidences of up staging (p = 0.02) and upgrading to 4 + 3 or greater disease (p = 0.046). Biochemical recurrence-free survival rates revealed no pairwise intergroup differences except between the low and high groups.
Patients with preoperatively elevated prostate specific antigen between 10 and less than 20 ng/ml who otherwise had histologically favorable risk prostate cancer were not at higher risk for adverse pathological outcomes than men with prostate specific antigen less than 10 ng/ml.
主动监测目前是低风险前列腺癌男性患者的首选治疗方法。尽管对于哪些患者适合进行主动监测尚无共识，但一般排除前列腺特异性抗原高于10 ng/ml的患者。为了确定使用10 ng/ml的前列腺特异性抗原临界值为考虑进行主动监测的男性提供咨询的有效性，我们分析了一个多机构数据库，以确定前列腺特异性抗原大于10 ng/ml但组织学风险较低的前列腺癌男性患者的病理结果。
我们查询了一个前瞻性维护的数据库，该数据库包含2003年至2015年间接受根治性前列腺切除术、组织学风险较低的前列腺癌男性患者。根据前列腺特异性抗原水平将该队列分为3组，包括低水平（低于10 ng/ml）、中等水平（10 ng/ml及以上至低于20 ng/ml）和高水平（20 ng/ml及以上）。分析前列腺特异性抗原组与不良病理和肿瘤学结果之间的关联。
在2125例患者中，1327例被归类为组织学风险较低的疾病。然而，多因素分析显示，中等和低前列腺特异性抗原组之间的分期升级和分级升级率相似。相比之下，与中等前列腺特异性抗原组相比，高前列腺特异性抗原组的分期升级发生率更高（p = 0.02），升级至4 + 3或更高分级疾病的发生率更高（p = 0.046）。生化无复发生存率显示，除低水平和高水平组之间外，组间无两两差异。
术前前列腺特异性抗原在10至低于20 ng/ml之间、组织学风险较低的前列腺癌患者，其不良病理结果的风险并不高于前列腺特异性抗原低于10 ng/ml的男性患者。
