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目的:探讨PSA最低值在前列腺癌雄激素剥夺治疗(ADT)中的临床意义。方法:回顾性分析1999年6月～2007年6月间采用双侧睾丸切除术治疗71例前列腺癌患者的临床资料,按照治疗后PSA最低值可否达到0.2 ng/ml为界,将患者分为两组,并作多参数比较。结果:诊断时平均年龄76.0(56～90)岁。双侧睾丸切除术后随访时间(43.9±27.8)个月,45例(63.4%)患者的PSA最低值≤0.2 ng/ml,26例(36.6%)>0.2 ng/ml,两组平均PSA最低值差异有统计学意义(P<0.002)。两组患者达到PSA最低值的时间差异无统计学意义(P>0.5),但≤0.2 ng/ml组维持PSA最低值的时间间隔(33.88个月)比>0.2 ng/ml组(16.53个月)长(P<0.05),≤0.2 ng/ml组5年累积PSA无进展存活率显著高于>0.2 ng/ml组(对数秩和检验,x~2=8.68,P<0.005),临床进展率(22%)低于>0.2 ng/ml组(50%)(x~2=5.80,P<0.025),患者总存活时间(48.4个月)高于>0.2 ng/ml组(33.1个月)(t 2.22,P<0.05)。因前列腺癌死亡的患者中,≤0.2 ng/ml组平均存活时间(58.2个月)高于>0.2 ng/ml组(19.8个月)(t=6.29,P<0.001)。结论:ADT后PSA最低值可能是前列腺癌患者对ADT治疗敏感程度的重要预示物,PSA最低值越低,前列腺癌的预后越好。ADT后PSA最低值未达0.2 ng/ml的患者可能处于生化和临床进展的高危状态。
Objective: To investigate the clinical significance of PSA minimum in androgen deprivation therapy (ADT) of prostate cancer. Methods: The clinical data of 71 patients with prostate cancer underwent bilateral orchiectomy between June 1999 and June 2007 were retrospectively analyzed. According to whether the minimum PSA value reached 0.2 ng / ml, the patients were divided into Two groups, and for more parameters comparison. Results: The mean age at diagnosis was 76.0 (56-90) years. The mean PSA was ≤0.2 ng / ml in 45 patients (63.4%) and> 0.2 ng / ml in 26 patients (36.6%), the lowest in both groups was 43.9 ± 27.8 months after bilateral orchiectomy. The difference was statistically significant (P <0.002). There was no significant difference in the time to PSA between the two groups (P> 0.5), but the time interval between the two groups (PSA> 0.22 ng / ml) ) (P <0.05). The cumulative 5-year progression-free survival (PSA) of ≤ 0.2 ng / ml group was significantly higher than that of> 0.2 ng / ml group The overall survival time (48.4 months) was higher than that of> 0.2 ng / ml group (33.1) (P <0.05) Month) (t 2.22, P <0.05). The mean survival time (58.2 months) in the group of ≤0.2 ng / ml was higher than that in the group of> 0.2 ng / ml (19.8 months) (t = 6.29, P <0.001) due to the death of prostate cancer. CONCLUSION: The lowest PSA level after ADT may be an important predictor of the sensitivity of patients with prostate cancer to ADT. The lower the PSA level, the better the prognosis of prostate cancer. Patients with a PSA lower than 0.2 ng / ml after ADT may be at a high risk of biochemical and clinical progression.