Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL.
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Urology. 2022 Dec;170:154-160. doi: 10.1016/j.urology.2022.08.014. Epub 2022 Aug 17.
To evaluate how blood levels of prostate-specific antigen (PSA) relate to prostate volume of benign tissue, Gleason pattern 3 (GP3) and Gleason pattern 4 (GP4) cancer.
The cohort included 2209 consecutive men undergoing radical prostatectomy at 2 academic institutions with pT2N0, Grade Group 1-4 prostate cancer and an undetectable postoperative PSA. Volume of benign, GP3, and GP4 were estimated. The primary analysis evaluated the association between PSA and volume of each type of tissue using multivariable linear regression. R, a measure of explained variation, was calculated using a multivariable model.
Estimated contribution to PSA was 0.04/0.06 ng/mL/cc for benign, 0.08/0.14 ng/mL/cc for GP3, and 0.62/0.80 ng/ml/cc for GP4 for the 2 independent cohorts, respectively. GP4 was associated with 6 to 8-fold more PSA per cc compared to GP3 and 15-fold higher compared to benign tissue. We did not observe a difference between PSA per cc for GP3 vs. benign tissue (P = 0.2). R decreased only slightly when removing age (0.006/0.018), volume of benign tissue (0.051/0.054) or GP3 (0.014/0.023) from the model. When GP4 was removed, R decreased 0.051/0.310. PSA density (PSA divided by prostate volume) was associated with volume of GP4 but not GP3, after adjustment for benign volume.
Gleason pattern 4 cancer contributes considerably more to PSA and PSA density per unit volume compared to GP3 and benign tissue. Contributions from GP3 and benign are similar. Further research should examine the utility of determining clinical management recommendations by absolute volume of GP4 rather than the ratio of GP3 to GP4.
评估前列腺特异性抗原（PSA）水平与良性组织、Gleason 模式 3（GP3）和 Gleason 模式 4（GP4）癌症的前列腺体积之间的关系。
该队列包括在 2 个学术机构接受根治性前列腺切除术的 2209 例连续男性患者，均为 pT2N0、Gleason 分级组 1-4 前列腺癌和术后 PSA 无法检测到的患者。估计良性组织、GP3 和 GP4 的体积。主要分析使用多变量线性回归评估 PSA 与每种组织体积之间的关系。使用多变量模型计算解释变异的 R 度量。
对于 2 个独立队列，良性组织、GP3 和 GP4 分别对 PSA 的估计贡献为 0.04/0.06ng/mL/cc、0.08/0.14ng/mL/cc 和 0.62/0.80ng/ml/cc。与 GP3 相比，GP4 每 cc 与 PSA 的相关性增加了 6 至 8 倍，与良性组织相比增加了 15 倍。我们没有观察到 GP3 与良性组织的每 cc PSA 之间存在差异（P=0.2）。当从模型中去除年龄（0.006/0.018）、良性组织体积（0.051/0.054）或 GP3 体积（0.014/0.023）时，R 略有下降。当去除 GP4 时，R 下降 0.051/0.310。调整良性组织体积后，PSA 密度（PSA 除以前列腺体积）与 GP4 体积相关，而与 GP3 体积无关。
与 GP3 和良性组织相比，Gleason 模式 4 癌症对 PSA 和单位体积 PSA 密度的贡献要大得多。GP3 和良性组织的贡献相似。进一步的研究应检查通过确定 GP4 的绝对体积而不是 GP3 与 GP4 的比值来确定临床管理建议的效用。
