Scilipoti Pietro, Garmo Hans, Gedeborg Rolf, Robinson David, Stattin Pär, Westerberg Marcus
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Division of Experimental Oncology/Unit of Urology, URI Institution, IRCCS Ospedale San Raffaele, Milan, Italy.
J Natl Cancer Inst. 2025 Jun 1;117(6):1142-1150. doi: 10.1093/jnci/djaf012.
There has been a wide range in incidence of prostate-specific antigen (PSA) persistence and relapse after radical prostatectomy (RP) for prostate cancer (PCa). We aimed to describe incidence and prognostic implications of PSA persistence and relapse.
Register-based cohort study in Sweden of men diagnosed with PCa between 2007 and 2020 who underwent RP. Risks were estimated using competing risk cumulative incidence curves. Treatment after persistence or relapse and risk of PCa death and other causes were stratified according to persistence, European Association of Urology relapse risk groups, time to relapse, and life expectancy based on age and comorbidities.
Among 10 700 men, the 10-year risk of PSA persistence or relapse after RP was 34% (95% confidence interval = 32% to 35%). Within 12 months of persistence/relapse, 75% of men with persistence, high-risk relapse, or early relapse (<2 years) received treatment. The 10-year risk of PCa death ranged from 12% for men with persistence to 2% in men with low-risk relapse, whereas death from other causes ranged from 11% to 16%. Risk of PCa death was 8.5% after early relapse (<2 years) and 1.4% after late relapse (>5 years).
This population-based study estimated that one-third of men would have PSA persistence or relapse within 10 years from RP. There was a wide range in risk of death from PCa according to cancer characteristics and time to relapse. Risk of death from other causes was substantial. These factors, along with life expectancy, should inform treatment decisions for men with persistence or relapse.
前列腺癌（PCa）根治性前列腺切除术（RP）后，前列腺特异性抗原（PSA）持续存在和复发的发生率差异很大。我们旨在描述PSA持续存在和复发的发生率及其预后意义。
在瑞典进行的一项基于登记的队列研究，研究对象为2007年至2020年间被诊断为PCa并接受RP的男性。使用竞争风险累积发病率曲线估计风险。根据PSA持续存在情况、欧洲泌尿外科学会复发风险组、复发时间以及基于年龄和合并症的预期寿命，对持续存在或复发后的治疗以及PCa死亡和其他原因导致的死亡风险进行分层。
在10700名男性中，RP后10年PSA持续存在或复发的风险为34%（95%置信区间=32%至35%）。在持续存在/复发的12个月内，75%的PSA持续存在、高风险复发或早期复发（<2年）的男性接受了治疗。PCa死亡的10年风险从PSA持续存在的男性中的12%到低风险复发男性中的2%不等，而其他原因导致的死亡风险则从11%到16%不等。早期复发（<2年）后PCa死亡风险为8.5%，晚期复发（>5年）后为1.4%。
这项基于人群的研究估计，三分之一的男性在RP后10年内会出现PSA持续存在或复发。根据癌症特征和复发时间，PCa死亡风险差异很大。其他原因导致的死亡风险也很高。这些因素以及预期寿命，应作为PSA持续存在或复发男性治疗决策的依据。
