Dirscherl Christian, Ebert Thomas, Schmitz-Dräger Bernd J, Goebell Peter J
Uniklinikum Erlangen und Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Deutschland.
Urologie. 2025 May 19. doi: 10.1007/s00120-025-02583-9.
Extremely high baseline prostate-specific antigen (bPSA) values in the range of 100 to ≥ 1000 ng/ml prior to the start of systemic therapy pose a challenge, as they can lead to the impression of a very unfavorable prognosis.
We investigated factors influencing 5‑year overall survival (5-yOS) and the treatment modalities of patients with bPSA levels ≥ 100 ng/ml using retrospective data.
We defined items from a limited initial collective, which we then used for a query in the UroCloud database. A total of 695 patients were included.
For the entire collective, the 5‑yOS was 68.5% ± 2.7%. The bPSA value had a significant (p < 0.001) influence on 5‑yOS in the following groups: 100-149 ng/ml, 150-249 ng/ml, 250-649 ng/ml, and ≥ 650 ng/ml (5-yOS: 77.0% ± 4.9% vs. 76.9% ± 4.5% vs. 61.4% ± 6.0 vs. 57.4% ± 6.1%, respectively). Age ≤ 70 years compared to > 70 years at first diagnosis resulted in a significant difference regarding 5‑yOS (74.8% ± 3.5% vs. 60.1% ± 4.4, respectively). A PSA response of > 90%, which was achieved in 79.0% of cases, had a significant influence on 5‑yOS compared to a response of ≤ 90% (73.5% ± 2.9% vs. 48.6% ± 6.7%, respectively). There was also a significant 5‑yOS advantage if a first PSA nadir of ≤ 0.20 ng/ml was achieved (in 22.2%) compared to a first PSA nadir of > 0.20 ng/ml (89.8% ± 3.3% vs. 60.4% ± 3.5%, respectively). In 49.4% (n = 343) of cases, androgen deprivation therapy (ADT) monotherapy was started as first-line systemic therapy. Between 1999 and 2023, we saw an increase in escalated and initial combination therapies. The analysis shows that an extreme bPSA value is not in itself an expression of an unfavorable prognosis.
在全身治疗开始前，前列腺特异性抗原（bPSA）基线值极高，范围在100至≥1000 ng/ml之间，这带来了挑战，因为它们可能导致预后非常不利的印象。
我们使用回顾性数据研究了影响bPSA水平≥100 ng/ml患者的5年总生存率（5-yOS）的因素以及治疗方式。
我们从有限的初始队列中定义项目，然后用于在UroCloud数据库中进行查询。共纳入695例患者。
对于整个队列，5年总生存率为68.5%±2.7%。bPSA值对以下组的5年总生存率有显著（p<0.001）影响：100 - 149 ng/ml、150 - 249 ng/ml、250 - 649 ng/ml和≥650 ng/ml（5年总生存率分别为77.0%±4.9%、76.9%±4.5%、61.4%±6.0%和57.4%±6.1%）。首次诊断时年龄≤70岁与>70岁相比，5年总生存率有显著差异（分别为74.8%±3.5%和60.1%±4.4%）。79.0%的病例实现了>90%的PSA反应，与≤90%的反应相比，对5年总生存率有显著影响（分别为73.5%±2.9%和48.6%±6.7%）。如果首次PSA最低点≤0.20 ng/ml（占22.2%），与首次PSA最低点>0.20 ng/ml相比，5年总生存率也有显著优势（分别为89.8%±3.3%和60.4%±3.5%）。在49.4%（n = 343）的病例中，雄激素剥夺疗法（ADT）单药治疗作为一线全身治疗开始。在1999年至2023年期间，我们看到强化和初始联合治疗有所增加。分析表明，极高的bPSA值本身并不表示预后不良。
