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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 454 -459. doi: 10.3877/cma.j.issn.1674-3253.2025.04.010

临床研究

雄激素剥夺治疗后PSA动态变化预测前列腺癌进展为去势抵抗性前列腺癌的价值
薛一博1, 景冠华2, 徐豪2, 张云天2, 束坤鹏2, 石红林2,†()   
  1. 1471000　洛阳，河南科技大学第二附属医院泌尿外科
    2450000　郑州，河南省人民医院泌尿外科
  • 收稿日期:2024-01-30 出版日期:2025-08-01
  • 通信作者: 石红林
  • 基金资助:
    河南省科技攻关项目(162102310172); 河南省人民医院科研基金(ZC20220296)

Value of PSA dynamic changes in predicting prostate cancer progression to castration-resistant prostate cancer after androgen deprivation therapy

Yibo Xue1, Guanhua Jing2, Hao Xu2, Yuntian Zhang2, Kunpeng Shu2, Honglin Shi2,†()   

  1. 1Department of Urology, the Second Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
    2Department of Urology, Henan Provincial People's Hospital, Zhengzhou 450000, China
  • Received:2024-01-30 Published:2025-08-01
  • Corresponding author: Honglin Shi
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引用本文：

薛一博, 景冠华, 徐豪, 张云天, 束坤鹏, 石红林. 雄激素剥夺治疗后PSA动态变化预测前列腺癌进展为去势抵抗性前列腺癌的价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(04): 454-459.

Yibo Xue, Guanhua Jing, Hao Xu, Yuntian Zhang, Kunpeng Shu, Honglin Shi. Value of PSA dynamic changes in predicting prostate cancer progression to castration-resistant prostate cancer after androgen deprivation therapy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(04): 454-459.

目的

分析前列腺癌（PCa）患者雄激素剥夺治疗（ADT）后前列腺特异性抗原（PSA）、游离PSA（fPSA）、fPSA/总PSA（f/tPSA）动态变化对疾病预后的预测价值。

方法

从河南省人民医院数据库中筛选经前列腺穿刺确诊为PCa的患者共519例，均接受ADT治疗，所有患者之前未接受过任何其他形式的前列腺癌相关治疗，并规律接受复查。最终78例进展为去势抵抗性前列腺癌（CRPC），通过COX分析PSA最小值（PSAn）、PSA达谷时间（TTPN）、骨转移评分、fPSA最小值（fPSAn）等指标与CRPC的关系，并通过受试者工作曲线计算其最佳临界值，最后通过K-M分析验证其可行性。

结果

骨转移评分、TTPN、PSAn、PSA是否下降至无法检测的水平、fPSAn、fPSA达谷时间（TTFPN）、治疗前f/tPSA、f/tPSA达峰时间是PCa患者进展为CRPC的独立危险因素。通过亚组分析得出PSAn越小，TTPN、TTFPN、f/tPSA达峰时间越长，患者进展为CRPC时间越长，并且经过ROC曲线得出最佳临界值为PSAn：0.214 ng/mL、TTPN：14.5个月、fPSAn：0.04 ng/mL、TTFPN：10.5个月、f/tPSA达峰时间：19个月。

结论

前列腺特异性抗原动态变化特征可有效预测前列腺癌患者雄激素剥夺治疗后进展为去势抵抗性前列腺癌的风险，为临床预后评估提供依据。

关键词: 前列腺肿瘤, 前列腺特异性抗原, 雄激素剥夺治疗, 预后分析
Objective

To analyse the predictive value of dynamic changes of prostate specific antigen (PSA), fPSA and f/tPSA on the prognosis of prostate cancer (PCa) patients after androgen deprivation therapy (ADT).

Methods

A total of 519 patients diagnosed with PCa by prostate biopsy were selected from the database of Henan Provincial People's Hospital. All patients received ADT treatment and had not received any other form of prostate cancer-related treatment previously, with regular follow-up conducted. Finally, 78 patients progressed to castration-resistant prostate cancer (CRPC). The relationship between PSA nadir (PSAn), time from ADT to PSA nadir (TTPN), bone metastasis score, fPSA nadir (fPSAn) and CRPC was calculated by COX analysis, and the optimal cut-off value was calculated by receiver operating characteristic curve, and finally its feasibility was verified by K-M analysis.

Results

Bone metastasis score, TTPN, PSAn and whether PSA decreased to undetectable levels, fPSAn, TTFPN, f/tPSA before treatment and f/tPSA peak time were independent risk factors for PCa patients to progress to CRPC. The smaller the PSAn, the longer the TTPN, TTFPN, the peak time of f/tPSA, the longer the patient's progression to CRPC, and the optimal cut-off value obtained by ROC curve was PSAn: 0.214 ng/mL, TTPN: 14.5 months, fPSAn: 0.04 ng/mL, TTFPN: 10.5 months, and f/tPSA peak time: 19 months.

Conclusion

Dynamic changes in prostate-specific antigen can effectively predict the risk of progression to castration-resistant prostate cancer in prostate cancer patients after androgen deprivation therapy, providing evidence for clinical prognosis assessment.

Key words: Prostate cancer, PSA, ADT, Prognostic analysis
表1 前列腺癌患者雄激素剥夺治疗后进展为CRPC相关危险因素的COX回归分析
  单因素 多因素
HR值 P值 95%CI HR值 P值 95%CI
年龄(岁) 0.972 0.035 0.947~0.998 1.010 0.512 0.980~1.041
BMI (kg/m2) 1.014 0.743 0.935~1.099      
TNM分期(低转移=0，高转移=1) 1.272 0.269 0.831~1.947      
EOD评分(分) 1.738 <0.001 1.323~2.282 1.520 0.011 1.101~2.099
病理类型(腺癌=0，导管内癌=1) 0.813 0.775 0.197~3.350      
Gleason评分(分) 1.102 0.501 0.830~1.463      
前列腺体积(ml) 1.005 0.170 0.998~1.012      
治疗前PSA (ng/mL) 1.000 0.495 1.000~1.000      
TTPN (月) 0.848 <0.001 0.806~0.891 0.696 <0.001 0.609~0.795
PSAn (ng/mL) 1.024 0.012 1.005~1.044 1.033 0.032 1.003~1.065
PSA是否下降至无法检测的水平(否=0，是=1) 0.554 0.049 0.308~0.996 0.062 <0.001 0.022~0.177
fPSA (治疗前，ng/mL) 1.002 0.062 1.000~1.004      
fPSAn (ng/mL) 1.190 0.001 1.074~1.318 0.999 0.989 0.837~1.192
TTFPN (月) 0.876 <0.001 0.835~0.919 0.967 0.470 0.884~1.058
f/tPSA（治疗前） 21.35 0.010 2.095~217.584 5.909 0.141 0.556~62.784
f/tPSA峰值 0.891 0.579 0.592~1.340      
f/tPSA达峰时间(月) 0.974 0.006 0.956~ 0.993 1.046 0.009 1.011~1.082
表2 前列腺癌患者雄激素剥夺治疗后进展为CRPC相关危险因素的COX回归分析（多因素）
  HR值 P值 95%CI
PSA (ng/mL)      
年龄(岁) 1.003 0.813 0.975~1.032
EOD评分(分) 1.483 0.011 1.097~2.007
TTPN (月) 0.725 <0.001 0.660~0.796
PSAn (ng/mL) 1.034 0.004 1.011~1.057
PSA是否下降至无法检测的水平(否=0，是=1) 0.068 <0.001 0.025~0.187
fPSA (ng/mL)      
年龄(岁) 1.002 0.910 0.973~1.031
EOD评分(分) 1.763 <0.001 1.339~2.320
TTFPN (月) 0.857 <0.001 0.810~0.907
fPSAn (ng/mL) 1.164 0.011 1.035~1.310
f/tPSA (ng/mL)      
年龄(岁) 0.977 0.119 0.948~1.006
EOD评分(分) 1.897 <0.001 1.440~2.498
治疗前f/tPSA 10.07 0.049 1.014~100.026
f/tPSA达峰时间(月) 0.975 0.010 0.957~0.994
图2 前列腺癌患者雄激素剥夺治疗后不同PSA最小值（PSAn）、PSA达谷时间（TTPN）、fPSA达谷时间（TTFPN）、PSA最小值（fPSAn）、f/tPSA达峰时间的K-M生存分析曲线
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