Lee W R, Hanks G E, Hanlon A
Department of Radiation Therapy, Fox Chase Cancer Center, Philadelphia, PA, USA.
J Clin Oncol. 1997 Jan;15(1):230-8. doi: 10.1200/JCO.1997.15.1.230.
To examine the natural history of patients who have received definitive radiation therapy alone for clinically localized prostate cancer and have an increasing prostate-specific antigen (PSA) profile.
One hundred fifty-one men with an increasing PSA profile after definitive radiotherapy were identified. The subsequent natural history of these men, including local recurrence, distant metastasis, and survival, was examined. In 119 men, posttreatment PSA doubling times (PSADT) were calculated using linear regression. Cox regression models were used to examine the effect of clinical and treatment variables on clinical failure and survival.
Patients with high pretreatment PSA values, high Gleason scores, and T3 tumors were more likely to develop a PSA elevation. The median calculated post-treatment PSADT was 13 months, and 95% of patients had posttreatment PSADT of less than 3 years. PSADT was correlated with tumor stage and Gleason score. Five years after PSA elevation, the estimated rate of clinical local recurrence is 26% and the estimated rate of distant metastases is 47%. Rapid PSADT (< 12 months) and a short interval from the end of treatment to PSA elevation (< 12 months) were significant independent predictors of distant metastases. The estimated rates of overall and cause-specific survival 5 years after PSA elevation are 65% and 76%, respectively. Gleason grade is the only significant independent predictor of overall and cause-specific survival after PSA elevation.
The natural history of men who have an increasing PSA profile following definitive radiotherapy is heterogeneous. In the absence of salvage therapy, at least three quarters of men will have clinical evidence of recurrent disease 5 years after a PSA elevation is detected. Men with a rapid posttreatment PSADT and a short interval from the end of treatment to an increasing PSA profile are at a very high risk of developing distant metastasis within 5 years of PSA elevation.
研究仅接受根治性放射治疗的临床局限性前列腺癌患者且前列腺特异性抗原（PSA）水平升高的自然病程。
确定了151例根治性放疗后PSA水平升高的男性患者。对这些男性患者随后的自然病程进行了研究，包括局部复发、远处转移和生存情况。在119例男性患者中，使用线性回归计算治疗后PSA倍增时间（PSADT）。采用Cox回归模型研究临床和治疗变量对临床失败和生存的影响。
治疗前PSA值高、Gleason评分高以及T3期肿瘤的患者更易出现PSA升高。计算得出的治疗后PSADT中位数为13个月，95%的患者治疗后PSADT小于3年。PSADT与肿瘤分期和Gleason评分相关。PSA升高5年后，估计临床局部复发率为26%，远处转移率为47%。快速PSADT（<12个月）以及从治疗结束至PSA升高的间隔时间短（<12个月）是远处转移的显著独立预测因素。PSA升高5年后的总生存率和病因特异性生存率估计分别为65%和76%。Gleason分级是PSA升高后总生存率和病因特异性生存率的唯一显著独立预测因素。
根治性放疗后PSA水平升高的男性患者自然病程具有异质性。在没有挽救性治疗的情况下，至少四分之三的男性患者在PSA升高检测到5年后会出现复发疾病的临床证据。治疗后PSADT快速且从治疗结束至PSA升高间隔时间短的男性患者在PSA升高5年内发生远处转移的风险非常高。
