Kan Hung-Cheng, Hou Chen-Pang, Lin Yu-Hsiang, Tsui Ke-Hung, Chang Phei-Lang, Chen Chien-Lun
Department of Urology, Chang Gung Memorial Hospital.
School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Onco Targets Ther. 2017 Jun 12;10:2943-2949. doi: 10.2147/OTT.S134411. eCollection 2017.
Prostate cancer patients with surprisingly high prostate-specific antigen (PSA) are encountered clinically. However, descriptions of this group of patients are extremely rare in the published literature. This study reports treatment outcome and long-term prognosis for this group of patients.
Between January 2007 and December 2012, 2,064 patients with PCa diagnosed at a tertiary medical center were retrospectively reviewed. A total of 90 PCa cases were identified with initial PSA (iPSA) >1,000 ng/mL at diagnosis. A retrospective study was conducted in this cohort, with comparison among stratified patient age groups, PSA, treatment options, and overall survival.
The mean PSA at PCa diagnosis in this cohort was 3,323 ng/mL (1,003-23,126, median: 2,050 ng/mL). Most patients were in the age group 65-79 years (55/90, 61%). Males older than 80 years had a poor prognosis (<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 (1.3-72.7) months, compared to 44 patients treated with medical castration and a median follow-up of 9.1 (0.3-70.5) months. Kaplan-Meier analysis revealed survival benefit from treatment with orchiectomy (<0.001). PSA reduction >90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (<0.001). Cox regression revealed the hazard ratio (HR) of variables were age (HR: 4.57, 95% confidence interval [CI]: 1.45-14.37, =0.009), reaching true nadir (HR: 0.12, 95% CI: 0.03-0.58, =0.008), and the treatment option with orchiectomy (HR: 0.22, 95% CI: 0.65-0.76, =0.016).
Age ≥80 years indicated poor overall survival in PCa patients with iPSA >1,000 ng/mL. Reaching a true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this group of patients.
临床上会遇到前列腺特异性抗原（PSA）水平出奇高的前列腺癌患者。然而，这组患者在已发表的文献中描述极为罕见。本研究报告了这组患者的治疗结果和长期预后。
回顾性分析2007年1月至2012年12月期间在一家三级医疗中心诊断为前列腺癌的2064例患者。共识别出90例前列腺癌患者，诊断时初始PSA（iPSA）>1000 ng/mL。对该队列进行回顾性研究，比较分层后的患者年龄组、PSA、治疗方案和总生存率。
该队列中前列腺癌诊断时的平均PSA为3323 ng/mL（1003 - 23126，中位数：2050 ng/mL）。大多数患者年龄在65 - 79岁组（55/90，61%）。80岁以上男性预后较差（<0.001）。46例患者（51%）接受了睾丸切除术，中位随访期为16.2（1.3 - 72.7）个月，相比之下，44例患者接受药物去势治疗，中位随访期为9.1（0.3 - 70.5）个月。Kaplan - Meier分析显示睾丸切除术治疗有生存获益（<0.001）。初次雄激素剥夺治疗后PSA降低>90%的iPSA（达到真正最低点）可能是更长生存期的预测指标（<0.001）。Cox回归显示各变量的风险比（HR）分别为年龄（HR：4.57，95%置信区间[CI]：1.45 - 14.37，P = 0.009）、达到真正最低点（HR：0.12，95% CI：0.03 - 0.58，P = 0.008）以及睾丸切除术治疗方案（HR：0.22，95% CI：0.65 - 0.76，P = 0.016）。
年龄≥80岁表明iPSA>1000 ng/mL的前列腺癌患者总体生存较差。初次雄激素剥夺治疗后达到PSA真正最低点可能是更长生存期的预测指标。建议对这组患者行双侧睾丸切除术。
