診斷時PSA初始值大1000 ng/ml之攝護腺癌的預後
甘弘成、侯鎮邦、林友翔、張慧朗、崔克宏、陳建綸
林口長庚紀念醫院 泌尿外科 外科部, 長庚大學
Prognosis of prostate cancer with initial PSA at diagnosis beyond 1000 ng/ml
Hung-Cheng Kan, Chen-Pang Hou, Yu-Hsiang Lin, Phei-Lang Chang, Ke-Hung Tsui, Chien-Lun Chen
Department of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University
Purpose: Surprisingly high PSA in aged men are encountered clinically. Documents describing this group of patients is extremely rare. We delineate the treatment outcomes and long term prognosis in this finite cohort of patients.
Materials and methods: We reviewed 90 prostate cancer patients with initial PSA (iPSA) at diagnosis over 1000 ng/ml at our institution. The stratified comparison among patient age, PSA, treatment options and survival were reported.
Results: The mean PSA at prostate cancer diagnosis in this cohort was 3323 ng/ml (1003 to 23126, median: 2050 ng/ml). Most patient aged between 65 and 79 years (61%). Aged men beyond 80 years had poor prognosis (p<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 months (1.3-72.7 mo), comparing to 44 patients treated with medical castration and a median follow-up of 9.1 months (0.3-70.5 mo). Kaplan-Meier analysis revealed survival benefit that treated with orchiectomy (p<0.001). PSA reduction more than 90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (p<0.001). Cox regression revealed the hazard ratio of variates were the age (HR: 4.57, 95%CI: 1.45-14.37, p=0.009), reaching true nadir (HR: 0.12, 95%CI: 0.03-0.58, p=0.008), and treatment option with orchiectomy (HR: 0.22, 95%CI: 0.65-0.76, p=0.016).
Conclusion: Patients older than 80 years had poor prognosis. Reaching true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this finite cohort of patients.