Gerber G S, Gornik H L, Goldfischer E R, Chodak G W, Rukstalis D B
Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA.
J Urol. 1998 Apr;159(4):1243-6.
We define changes in prostate specific antigen (PSA) measurements with time in 49 men 71.9 +/- 7.0 years old (mean plus or minus standard deviation) with clinically localized prostate cancer who remain untreated.
We retrospectively analyzed PSA changes in prostate cancer patients managed by watchful waiting. In all patients a minimum of 3 PSA levels were measured at intervals of at least 6 months after malignancy was diagnosed. The rate of change in serum PSA level with time (PSA velocity) was determined using an exponential, log linear model.
In 49 patients treated conservatively mean initial PSA level plus or minus standard deviation was 12.3 +/- 11.1 ng./ml. and mean PSA followup during which no therapy for prostate cancer was introduced was 32.1 +/- 13.2 months. PSA levels decreased during the observation period in 11 of the 49 patients (22%) and median PSA doubling time in the remaining 38 was 55.7 months (range 15.1 to 994.5). There was no significant correlation between age at diagnosis, Gleason sum, initial PSA level or clinical stage and PSA velocity. The short-term rate of change in PSA during the first 9 months after prostate cancer was diagnosed correlated poorly with overall PSA velocity. The short-term rate of PSA change was greater than the overall rate of change in 14 of 37 patients (38%).
There is significant variability in the rate of change of PSA with time in men with clinically localized prostate cancer who remain untreated. The usefulness of serial PSA measurements in the management of watchful waiting is unclear. Changes in PSA may not be helpful or appropriate in determining the need for therapy after a period of observation.
我们定义了49名年龄为71.9±7.0岁（均值±标准差）、患有临床局限性前列腺癌且未接受治疗的男性患者前列腺特异性抗原（PSA）测量值随时间的变化情况。
我们回顾性分析了采用观察等待管理的前列腺癌患者的PSA变化情况。所有患者在确诊恶性肿瘤后，至少每6个月测量一次PSA水平，且至少测量3次。使用指数对数线性模型确定血清PSA水平随时间的变化率（PSA速度）。
在49名接受保守治疗的患者中，初始PSA水平均值±标准差为12.3±11.1 ng/ml，在未进行前列腺癌治疗期间的PSA随访均值为32.1±13.2个月。在49名患者中，有11名（22%）在观察期内PSA水平下降，其余38名患者的PSA中位倍增时间为55.7个月（范围为15.1至994.5个月）。诊断时的年龄、Gleason评分、初始PSA水平或临床分期与PSA速度之间均无显著相关性。前列腺癌诊断后的前9个月内，PSA的短期变化率与总体PSA速度的相关性较差。在37名患者中，有14名（38%）的PSA短期变化率大于总体变化率。
患有临床局限性前列腺癌且未接受治疗的男性患者，其PSA随时间的变化率存在显著差异。在观察等待管理中，连续进行PSA测量的作用尚不清楚。在观察一段时间后，PSA的变化可能无助于或不适用于确定是否需要治疗。
