Sciarra Alessandro, Maggi Martina, Fasulo Andrea, Salciccia Stefano, Gentile Vincenzo, Cattarino Susanna, Gentilucci Alessandro
Department of Urology, Sapienza University, Rome - Italy.
Department of Statistic, Istituto Superiore di Sanità, Rome - Italy.
Urologia. 2017 Aug 1;84(3):158-164. doi: 10.5301/uj.5000227. Epub 2017 Apr 4.
The aim of this study was to analyze the significance of an increase in total prostate-specific antigen (PSA) serum levels despite dutasteride treatment as a predictor of prostate cancer (PC) at biopsy. We focused our attention on the rate of the first PSA increase and on the influence of prostatic inflammation.
From 2011 to 2016, 365 men with a previous negative prostate biopsy and persistent elevated PSA levels received dutasteride treatment. The population was followed for a range of 12-48 months.
One hundred twelve cases with a confirmed PSA increase >0.5 ng/ml over the nadir value during the follow-up were included in Group A and underwent a new prostate biopsy. In Group A, the PSA increase was associated with PC at the re-biopsy in 66% of cases. The percentage of PSA reduction after 6 months of treatment was not a significant indicator of the risk for PC. The distribution of inflammatory infiltrates significantly (p<00.01) varied from positive to negative prostate biopsies. The relative risk for PC at biopsy significantly increased according to PSA level during dutasteride.
Treatment with dutasteride can help to analyze PSA kinetic. A persistent prostatic inflammation is a factor able to reduce the performance of PSA kinetic during dutasteride treatment.
本研究的目的是分析在接受度他雄胺治疗的情况下，血清总前列腺特异性抗原（PSA）水平升高作为活检时前列腺癌（PC）预测指标的意义。我们关注首次PSA升高的速率以及前列腺炎症的影响。
2011年至2016年，365名先前前列腺活检结果为阴性且PSA水平持续升高的男性接受了度他雄胺治疗。对这些人群进行了12至48个月的随访。
在随访期间，112例确认PSA较最低点升高>0.5 ng/ml的患者被纳入A组，并接受了新的前列腺活检。在A组中，66%的病例在再次活检时PSA升高与前列腺癌有关。治疗6个月后PSA降低的百分比不是前列腺癌风险的显著指标。炎症浸润的分布在前列腺活检阳性和阴性之间有显著差异（p<0.01）。根据度他雄胺治疗期间的PSA水平，活检时患前列腺癌的相对风险显著增加。
度他雄胺治疗有助于分析PSA动力学。持续性前列腺炎症是一个能够降低度他雄胺治疗期间PSA动力学性能的因素。
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