Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Urol Oncol. 2020 May;38(5):379-385. doi: 10.1016/j.urolonc.2019.12.027. Epub 2020 Jan 27.
To analyze oncological outcomes of very high-risk patients with initial PSA 50-99.9 and ≥100 ng/ml who underwent radical prostatectomy (RP) for clinically localized prostate cancer.
Overall, 2,811 RP patients (1992-2018) with negative preoperative CT-scan and bone scintigraphy were included. The impact of preoperative PSA level, categorized as 20-49.9 (n = 2,195) vs. 50-99.9 (n = 454) vs. ≥100 ng/ml (n = 162) on biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS) and cancer-specific survival (CSS) was assessed using Kaplan-Meier and multivariable Cox regression models.
Median follow-up was 47.5 months. Ten-year BCR-free survival rates were 46.9 vs. 32.1 vs. 29.0% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml, respectively (P < 0.001). Ten-year MFS rates were 78.4 vs. 67.2 vs. 37.3% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml (P < 0.001). 10-year CSS rates were 93.7 vs. 85.5 vs. 66.7% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml (P < 0.001). In multivariable analyses, PSA-categories 50-99.9 ng/ml and ≥100 ng/ml were independently predicting higher risk of BCR (hazard ratio [HR]: 1.3 and 1.4), metastatic progression (HR: 1.4 and 2.3), and cancer-specific mortality (CSM, HR: 1.9 and 3.4) compared with PSA-category 20-49.9 ng/ml.
Initial PSA levels ≥50 ng/ml are associated with higher risk of BCR, metastatic progression, and CSM compared with high-risk patients with PSA of 20-49.9 ng/ml. In consequence, these patients may be counseled about a potentially increased risk of undetected metastases prior to RP possibly necessitating intensified multimodal treatments in the future.
分析初始 PSA 为 50-99.9 和≥100ng/ml 的极高危患者接受根治性前列腺切除术（RP）治疗临床局限性前列腺癌的肿瘤学结果。
共纳入 2811 例接受 RP 的患者（1992-2018 年），术前 CT 扫描和骨闪烁扫描均为阴性。使用 Kaplan-Meier 和多变量 Cox 回归模型评估术前 PSA 水平（分为 20-49.9ng/ml[n=2195]、50-99.9ng/ml[n=454]和≥100ng/ml[n=162]）对生化复发（BCR）无复发生存率、无转移生存率（MFS）和癌症特异性生存率（CSS）的影响。
中位随访时间为 47.5 个月。在 PSA 20-49.9ng/ml、50-99.9ng/ml 和≥100ng/ml 分组中，10 年 BCR 无复发生存率分别为 46.9%、32.1%和 29.0%（P<0.001）。10 年 MFS 率分别为 78.4%、67.2%和 37.3%（P<0.001）。在 PSA 20-49.9ng/ml、50-99.9ng/ml 和≥100ng/ml 分组中，10 年 CSS 率分别为 93.7%、85.5%和 66.7%（P<0.001）。多变量分析显示，PSA 50-99.9ng/ml 和≥100ng/ml 亚组与 PSA 20-49.9ng/ml 亚组相比，BCR（危险比[HR]：1.3 和 1.4）、转移性进展（HR：1.4 和 2.3）和癌症特异性死亡率（CSM，HR：1.9 和 3.4）的风险更高。
与 PSA 20-49.9ng/ml 的高危患者相比，初始 PSA 水平≥50ng/ml 与 BCR、转移性进展和 CSM 的风险增加相关。因此，在接受 RP 治疗之前，这些患者可能需要接受潜在转移灶的强化多模式治疗，这可能需要进一步评估。
