Chauvet B, Félix-Faure C, Lupsascka N, Fijuth J, Brewer Y, Davin J L, Kirscher S, Reboul F
Department of Urological Oncology, Clinique Ste Catherine, Avignon, France.
J Clin Oncol. 1994 Jul;12(7):1402-7. doi: 10.1200/JCO.1994.12.7.1402.
To assess the prognostic significance of serum prostate-specific antigen (PSA) in the monitoring of patients with localized prostate cancer treated with primary radiation therapy, we analyzed the data from 179 patients treated at our institution between 1987 and 1990.
One hundred seventy-nine previously untreated patients received radiation at 69 Gy to the prostate with curative intent for prostate adenocarcinoma. The median follow-up duration is now 41 months. PSA levels were measured before radiotherapy and then evaluated periodically.
Baseline levels were greater than 4 ng/mL in 83% of cases and were significantly correlated with clinical tumor stage (P = .002). Six months after completion of therapy, PSA values had returned to normal in 53% of the patients with initially elevated values. At the time of analysis, 32 patients have relapsed, including three of 30 patients (10%) with normal initial and 6-month values, five of 79 patients (6%) with initially elevated but normal 6-month values, and 24 of 69 patients (35%) with persistently elevated PSA levels at 6 months. Actuarial 4-year relapse-free survival was significantly correlated with initial and 6-month PSA values (84% in patients with normal 6-month values v 60% in patients with persistently elevated levels). Furthermore, when the relative decline between initial and 6-month PSA values exceeded 50%, the crude rate of recurrence was 14% as opposed to 34% when it failed to exceed 50%. The 4-year relapse-free survival rates were 77% and 59%, respectively (P = .008). By multivariate analysis restricted to the patients with elevated baseline PSA levels, the rate of decline of PSA values reached the highest prognostic significance (P < .0001). Age at diagnosis, clinical tumor stage, and Gleason score only reached statistical significance in univariate analysis.
PSA values are of major prognostic significance in assessing the 4-year results of radical radiation therapy for localized prostate cancer. The rate of decline of PSA values is the strongest predictor of outcome and might help to identify a subset of patients with poorer prognosis who may benefit from early hormonal therapy.
为评估血清前列腺特异性抗原（PSA）在监测接受原发性放射治疗的局限性前列腺癌患者中的预后意义，我们分析了1987年至1990年间在我院接受治疗的179例患者的数据。
179例既往未接受过治疗的患者接受了69 Gy前列腺放疗，目的是治愈前列腺腺癌。目前的中位随访时间为41个月。放疗前测量PSA水平，然后定期评估。
83%的病例基线水平大于4 ng/mL，且与临床肿瘤分期显著相关（P = 0.002）。治疗完成6个月后，初始值升高的患者中有53%的PSA值恢复正常。在分析时，32例患者复发，包括初始值和6个月值正常的30例患者中的3例（10%），初始值升高但6个月值正常的79例患者中的5例（6%），以及6个月时PSA水平持续升高的69例患者中的24例（35%）。4年无复发生存率与初始和6个月时的PSA值显著相关（6个月值正常的患者为84%，而PSA水平持续升高的患者为60%）。此外，当初始和6个月时PSA值的相对下降超过50%时，复发粗率为14%，而未超过50%时为34%。4年无复发生存率分别为77%和59%（P = 0.008）。在对基线PSA水平升高的患者进行多因素分析时，PSA值的下降率具有最高的预后意义（P < 0.0001）。诊断时年龄、临床肿瘤分期和Gleason评分仅在单因素分析中具有统计学意义。
PSA值在评估局限性前列腺癌根治性放射治疗的4年结果中具有重要的预后意义。PSA值的下降率是预后的最强预测指标，可能有助于识别预后较差的患者亚组，这些患者可能从早期激素治疗中获益。
