Nam R K, Klotz L H, Jewett M A, Danjoux C, Trachtenberg J
Division of Urology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Br J Urol. 1998 Jan;81(1):100-4. doi: 10.1046/j.1464-410x.1998.00523.x.
To study the rate of change in prostate specific antigen (PSA velocity) in patients with prostate cancer initially managed by 'watchful waiting'.
Serial PSA levels were determined in 141 patients with prostate cancer confirmed by biopsy, who were initially managed expectantly and enrolled between May 1990 and December 1995. Sixty-seven patients eventually underwent surgery (mean age 59 years) because they chose it (the decision for surgery was not based on PSA velocity). A cohort of 74 patients remained on 'watchful waiting' (mean age 69 years). Linear regression and logarithmic transformations were used to segregate those patients who showed a rapid rise, defined as a > 50% rise in PSA per year (or a doubling time of < 2 years) and designated 'rapid risers'.
An initial analysis based on a minimum of two PSA values showed that 31% were rapid risers. Only 15% of patients with more than three serial PSA determinations over > or = 6 months showed a rapid rise in PSA level. There was no advantage of log-linear analysis over linear regression models.
Three serial PSA determinations over > or = 6 months in patients with clinically localized prostate cancer identifies a subset (15%) of patients with a rapidly rising PSA level. Shorter PSA surveillance with fewer PSA values may falsely identify patients with rapid rises in PSA level. However, further follow-up is required to determine if a rapid rise in PSA level identifies a subset of patients with an aggressive biological phenotype who are either still curable or who have already progressed to incurability through metastatic disease.
研究最初采用“密切观察等待”管理的前列腺癌患者的前列腺特异性抗原变化率（PSA速度）。
对141例经活检确诊为前列腺癌的患者进行系列PSA水平测定，这些患者最初采用期待性管理，于1990年5月至1995年12月入组。67例患者最终接受了手术（平均年龄59岁），因为他们选择了手术（手术决策并非基于PSA速度）。一组74例患者继续“密切观察等待”（平均年龄69岁）。采用线性回归和对数转换来区分那些PSA快速上升的患者，即每年PSA上升>50%（或倍增时间<2年），并将其定义为“快速上升者”。
基于至少两个PSA值的初步分析显示，31%为快速上升者。在≥6个月内进行了三次以上系列PSA测定的患者中，只有15%的患者PSA水平快速上升。对数线性分析并不优于线性回归模型。
对临床局限性前列腺癌患者在≥6个月内进行三次系列PSA测定，可识别出一部分（15%）PSA水平快速上升的患者。PSA监测时间较短且PSA值较少可能会错误地识别出PSA水平快速上升的患者。然而，需要进一步随访以确定PSA水平快速上升是否能识别出一部分具有侵袭性生物学表型的患者，这些患者要么仍可治愈，要么已经因转移性疾病进展为不可治愈。
