Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press38010.17650/1726-9776-2014-10-3-59-63PROSTATE CANCERРАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫTime to biochemical recurrence after radical prostatectomy is an important predictor of clinical progression, distant metastases and cancer-specific deathВремя до развития био химического рецидива после радикальной прост атэктомии – значимый предиктор клинической прогрессии, о тдаленного метастазирования и раковоспецифической смертностиVelievE. I.ВелиевЕ. И.
Russian Federation
SokolovE. A.СоколовЕ. А.
Russian Federation
rmapo@yandex.ruLoranO. B.ЛоранО. Б.
Russian Federation
PetrovS. B.ПетровС. Б.
Russian Federation
LukyanovI. V.ЛукьяновИ. В.
Russian Federation
SereginA. V.СерегинА. В.
Russian Federation
BogdanovA. B.БогдановА. Б.
Russian Federation
Department of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, MoscowКафедра урологии и хирургической андрологии ГБОУ ДПО РМАПО Минздрава России, МоскваA.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Ministry of Emergency Situations of Russia, Saint PetersburgФГБУ «Всероссийский центр экстренной и радиационной медицины им. А.М. Никифорова» МЧС России, Санкт-Петербург30092014103596309112014https://oncourology.abvpress.ru/oncur/article/view/380

Prostate-specific antigen is a sensitive marker for recurrent prostate cancer (PC) after radical prostatectomy (RPE), which can predict thedevelopment of clinical progression and distant metastases well long before they occur. The objective of the investigation was to analyze the relationship of the time to biochemical recurrence (BCR) after RPE to the development of clinical progression, distant metastases, and PC death. The vast majority (80.5 %) of BCRs was common within the first 2 years after RPE and the recurrence was attended by the highest rate of clinical progression, metastases, and PC death during the first year. Correlation analysis shows that there is a statistically significant inverse correlation between the time to BCR following RPE with the development of clinical progression (rs = -0.43; p < 0.001), metastases (rs = -0.46; p < 0.001), and PC death (rs = -0.41; p < 0.001). Regardless of the time to recurrence, none of 27 patients with favorable histological characteristics (a total of post-RPE Gleason scores of ≤ 6, organ-confined disease, and a negative surgical margin) developed distant metastases; only one case had a local tumor recurrence.

Простатспецифический антиген является чувствительным маркером рецидива рака предстательной железы (РПЖ) после радикальной простатэктомии (РПЭ), позволяющим прогнозировать развитие клинической прогрессии и отдаленного метастазирования задолго до их появления. Цель исследования – анализ взаимосвязи времени до развития биохимического рецидива (БХР) после РПЭ с развитием клинической прогрессии, отдаленного метастазирования и смерти от РПЖ. Подавляющее большинство БХР (80,5 %) выявлено в первые 2 года после РПЭ, а рецидив в течение первого года сопровождался наибольшей частотой клинической прогрессии, метастазирования и смерти от РПЖ. Корреляционный анализ показывает: время до БХР после РПЭ имеет статистически значимую обратную связь с развитием клинической прогрессии (rs = –0,43, p < 0,001), метастазированием (rs = –0,46, p < 0,001) и смертью от РПЖ (rs = –0,41, p < 0,001). Ни у одного из 27 пациентов с благоприятными гистологическими характеристиками (сумма баллов по шкале Глисона после РПЭ ≤ 6, орган-локализованное заболевание, отрицательный хирургический край) независимо от времени рецидива не развилось отдаленное метастазирование, и лишь в 1 случае имел место местный рецидив опухоли.

prostate cancerradical prostatectomybiochemical recurrenceclinical progressionprostate-specific antigenрак предстательной железырадикальная простатэктомиябиохимический рецидивклиническая прогрессияпростатспецифический антиген1. Stamey T.A., Yang N., Hay A.R. et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987;317:909–16.Stamey T.A., Yang N., Hay A.R. et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987;317:909–16.2. Heidenreich A., Bastian P.J., Bellmunt J. et al. Part 1: Screening, diagnosis and treatment of clinically localised disease. Eur Urol 2011;59:61–71.Heidenreich A., Bastian P.J., Bellmunt J. et al. Part 1: Screening, diagnosis and treatment of clinically localised disease. Eur Urol 2011;59:61–71.3. Pound C.R., Partin A.W., Eisenberger M.A. et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999;281:1591–7.Pound C.R., Partin A.W., Eisenberger M.A. et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999;281:1591–7.4. Freedland S.J., Sutter M.E., Dorey F., Aronson W.J. Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate-specific antigen. Urology 2003;61:365–9.Freedland S.J., Sutter M.E., Dorey F., Aronson W.J. Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate-specific antigen. Urology 2003;61:365–9.5. Amling C.L., Blute M.L., Bergstralh E.J. et al. Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J Urol 2000;164:101–5.Amling C.L., Blute M.L., Bergstralh E.J. et al. Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J Urol 2000;164:101–5.6. Caire A.A., Sun L., Ode O. et al. Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes? Urology 2009;74:643–7.Caire A.A., Sun L., Ode O. et al. Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes? Urology 2009;74:643–7.7. Bolton D.M., Ta A., Bagnato M. et al. Interval to biochemical recurrence following radical prostatectomy does not affect survival in men with low-risk prostate cancer. World J Urol 2013; Jul 4. doi: 10.1007/s00345-013-1125-0. [Epub ahead of print].Bolton D.M., Ta A., Bagnato M. et al. Interval to biochemical recurrence following radical prostatectomy does not affect survival in men with low-risk prostate cancer. World J Urol 2013; Jul 4. doi: 10.1007/s00345-013-1125-0. [Epub ahead of print].8. Велиев Е.И., Петров С.Б., Лоран О.Б. и др. Радикальная позадилонная простатэктомия: первый российский опыт 15-летнего наблюдения после операции. Онкоурология 2013;2:57–62.Велиев Е.И., Петров С.Б., Лоран О.Б. и др. Радикальная позадилонная простатэктомия: первый российский опыт 15-летнего наблюдения после операции. Онкоурология 2013;2:57–62.9. Коган М.И., Лоран О.Б., Петров С.Б. Радикальная хирургия рака предстательной железы. М.: ГЭОТАР-Медиа, 2006; с. 352.Коган М.И., Лоран О.Б., Петров С.Б. Радикальная хирургия рака предстательной железы. М.: ГЭОТАР-Медиа, 2006; с. 352.10. Hansen J., Bianchi M., Sun M. et al. Percentage of high-grade tumor volume does not meaningfully improve prediction of early biochemical recurrence after radical prostatectomy compared to Gleason score. BJU Int 2014;113:399–407.Hansen J., Bianchi M., Sun M. et al. Percentage of high-grade tumor volume does not meaningfully improve prediction of early biochemical recurrence after radical prostatectomy compared to Gleason score. BJU Int 2014;113:399–407.11. D’Amico A.V., Whittington R., Malkowicz B.S. et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969–74.D’Amico A.V., Whittington R., Malkowicz B.S. et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969–74.12. Stephenson A.J., Scardino P.T., Eastham J.A. et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005;23:7005–12.Stephenson A.J., Scardino P.T., Eastham J.A. et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005;23:7005–12.13. Mullins J.K., Feng Z., Trock B.J. et al. The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 2012;188: 2219–24.Mullins J.K., Feng Z., Trock B.J. et al. The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 2012;188: 2219–24.14. Roehl K.A., Han M., Ramos C.G. et al. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004;172:910–4.Roehl K.A., Han M., Ramos C.G. et al. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004;172:910–4.15. Freedland S.J., Humphreys E.B., Mangold L.A. et al. Time to prostate specific antigen recurrence after radical prostatectomy and risk of prostate cancer specific mortality. J Urol 2006;176:1404–8.Freedland S.J., Humphreys E.B., Mangold L.A. et al. Time to prostate specific antigen recurrence after radical prostatectomy and risk of prostate cancer specific mortality. J Urol 2006;176:1404–8.16. Ward J.F., Blute M.L., Slezal K. et al. The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003;170:1872–6.Ward J.F., Blute M.L., Slezal K. et al. The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003;170:1872–6.17. Antonarakis E.S., Feng Z., Trock B.J. et al. The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: longterm follow-up. BJU Int 2011;109:32–9.Antonarakis E.S., Feng Z., Trock B.J. et al. The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: longterm follow-up. BJU Int 2011;109:32–9.18. Dale W., Hemmerich J., Bylow K. et al. Patient anxiety about prostate cancer independently predicts early initiation of androgen deprivation therapy for biochemical cancer recurrence in older men: a prospective cohort study. J Clin Oncol 2009;27:1557–63.Dale W., Hemmerich J., Bylow K. et al. Patient anxiety about prostate cancer independently predicts early initiation of androgen deprivation therapy for biochemical cancer recurrence in older men: a prospective cohort study. J Clin Oncol 2009;27:1557–63.19. Tollefson M.K., Blute M.L., Rangel L.J. et al. Lifelong yearly prostate specific antigen surveillance is not necessary for low risk prostate cancer treated with radical prostatectomy. J Urol 2010;184:925–9.Tollefson M.K., Blute M.L., Rangel L.J. et al. Lifelong yearly prostate specific antigen surveillance is not necessary for low risk prostate cancer treated with radical prostatectomy. J Urol 2010;184:925–9.20. Loeb S., Feng Z., Ross A. et al. Can we stop prostate specific antigen testing 10 years after radical prostatectomy? J Urol 2011;106:500–5.Loeb S., Feng Z., Ross A. et al. Can we stop prostate specific antigen testing 10 years after radical prostatectomy? J Urol 2011;106:500–5.