Cadeddu J A, Pearson J D, Partin A W, Epstein J I, Carter H B
Department of Urology, Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Urology. 1993 Oct;42(4):383-9. doi: 10.1016/0090-4295(93)90362-e.
Changes in prostate-specific antigen (PSA), used to estimate PSA doubling times, may reflect prostate cancer growth. To determine if PSA doubling time prior to diagnosis predicted outcome in men with prostate cancer, we evaluated 16 men with prostate cancer who had (1) serial PSA determinations (mean 9.9) on frozen sera from twelve to twenty-six years before diagnosis; (2) at least five years of follow-up in those subjects without metastatic disease (range 5.5-12.3 years); and (3) archival material from diagnosis available for pathologic evaluation. PSA doubling time prior to diagnosis was investigated with relation to patient outcome (regardless of treatment) and the known predictors of tumor behavior, Gleason score and nuclear morphometry. In 5 of 16 men who had evidence of metastatic disease at diagnosis, metastasis developed or they died of prostate cancer during follow-up (group 1). Eleven of 16 had no evidence of metastatic disease during follow-up (group 2). Both Gleason score and variance of nuclear roundness (VNR) were significantly greater for group 1 (p < 0.05). There was no significant difference between the two groups with respect to PSA doubling time, and the PSA level at diagnosis did not correlate with the development of metastatic disease. One of 5 men with no PSA level greater than 4.0 ng/mL prior to diagnosis died within two years of diagnosis. These data suggest that (1) a normal PSA at diagnosis does not exclude an aggressive cancer, and (2) changes in PSA that occur before the diagnosis of prostate cancer may not always predict outcome. Since PSA level is influenced by tumor grade, an inability to correct PSA for tumor grade could have influenced the results.
用于估计前列腺特异性抗原（PSA）倍增时间的变化可能反映前列腺癌的生长情况。为了确定诊断前的PSA倍增时间是否能预测前列腺癌男性患者的预后，我们评估了16例前列腺癌男性患者，这些患者具备以下条件：（1）在诊断前12至26年的冷冻血清上进行了系列PSA测定（平均9.9次）；（2）在无转移疾病的患者中进行了至少5年的随访（范围为5.5 - 12.3年）；（3）有诊断时的存档材料可用于病理评估。研究了诊断前的PSA倍增时间与患者预后（无论治疗情况如何）以及已知的肿瘤行为预测指标、Gleason评分和核形态测量之间的关系。在16例诊断时有转移疾病证据的男性患者中，5例在随访期间出现转移或死于前列腺癌（第1组）。16例中有11例在随访期间无转移疾病证据（第2组）。第1组的Gleason评分和核圆度方差（VNR）均显著更高（p < 0.05）。两组在PSA倍增时间方面无显著差异，且诊断时的PSA水平与转移疾病的发生无关。5例诊断前PSA水平未超过4.0 ng/mL的男性患者中有1例在诊断后两年内死亡。这些数据表明：（1）诊断时PSA正常并不能排除侵袭性癌症；（2）前列腺癌诊断前发生的PSA变化可能并不总是能预测预后。由于PSA水平受肿瘤分级影响，无法对肿瘤分级校正PSA可能影响了结果。
