Значение ультрачувствительного метода количественного определения простатического специфического антигена в диагностике рецидива рака предстательной железы
Значение ультрачувствительного метода количественного определения простатического специфического антигена в диагностике рецидива рака предстательной железы
Значение ультрачувствительного метода количественного определения простатического специфического антигена в диагностике рецидива рака предстательной железы
Общепризнанным вариантом лечения рака предстательной железы на протяжении последних 15 лет является радикальная позадилонная простатэктомия (РПЭ). Вместе с тем, по данным разных авторов, примерно у 22–50% пациентов с локализованным раком предстательной железы после РПЭ выявляется распространение опухолевого процесса за пределы органа, и в последующем примерно у 15–44% пациентов развивается рецидив заболевания. В литературе, посвященной изучению факторов прогноза биохимического рецидива, значительное место отводится обсуждению ультрачувствительных методов количественного определения сывороточного простатического специфического антигена (ПСА). Несколько исследований показали, что главной ценностью сверхмалых значений ПСА может являться выделение пациентов группы высокого риска прогрессирования и, как следствие, раннее выявление рецидива заболевания. Другие авторы полагают, что данный метод обладает минимальными преимуществами и часто вызывает неоправданное беспокойство у пациентов с клинически незначимым повышением уровня ПСА.
Ключевые слова: радикальная простатэктомия, биохимический рецидив, ультрачувствительные методы определения простатического специфического антигена.
________________________________________________
The most effective variant of prostate cancer treatment has been the radical prostatectomy (RP) during the past 15 years. According to the results obtained from the different authors approximately 22–50% of patients with the localized prostate cancer reveal extracapsular extension after radical prostatectomy, and further about 15–44% of patients go on to develop cancer recurrence. In the literature dedicated to the investigation of prognostic factors of biochemical recurrence, the important part is taken by the discussion of ultrasensitive PSA assays. Several researchers have shown that ultrasensitive Prostate-Specific Antigen (USPSA) assays can help to identify the patients at a high risk for prostate cancer progression and so to reveal cancer recurrence rather earlier. Other authors suppose that this method has minimum advantages and often causes undue anxiety in patients with clinically insignificant increase of PSA level.
1. Велиев Е.И. Оптимизация хирургического лечения больных локализованным раком предстательной железы. Дис. … д-ра мед. наук. СПб., 2003.
2. Zincke H, Oesterling JE, Blute ML et al. Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 1994; 152 (5 Pt 2): 1850–7.
3. Liu L, Coker AL, Du XL et al. Long-term survival after radical prostatectomy compared to other treatments in older men with local/regional prostate cancer. J Surg Oncol 2008; 97: 583–91.
4. Krongrad A, Lai H, Lai S. Survival after radical prostatectomy. JAMA 1997; 278 (1): 44–6.
5. Kupelian PA, Katcher J, Levin HS et al. Stage T1–2 prostate cancer a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Int J Radiat Oncol Biol Phys 1997; 37: 1043–52.
6. Catalona WJ, Smith DS. 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol 1994; 152: 1837–42.
7. Walsh PC, Partin AW, Epstein JI. Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. J Urol 1994; 152 (5): 1831–6.
8. Frazier HA, Robertson JE, Humphrey PA et al. Is prostate specific antigen of clinical importance in evaluating outcome after radical prostatectomy. J Urol 1993; 149 (3): 516–8.
9. Hull GW, Rabbani F, Abbas F et al. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 2002; 167 (2 Pt 1): 528–34.
10. Grossfeld GD, Chang JJ, Broering JM et al. Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy? Data fr om the CAPSURE database. Urology 2000; 56 (3): 430–5.
11. Han M, Partin AW, Zahurak M et al. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003; 169 (2): 517–23.
12. Amling CL, Blute ML, Bergstralh EJ 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 (2): 101–5.
13. Roehl KA, Han M, Ramos CG et al. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004; 172 (3): 910–4.
14. Porter CR, Gallina A, Kodama K et al. Prostate cancer-specific survival in men treated with hormonal therapy after failure of radical prostatectomy. Eur Urol 2007; 52 (2): 446–52.
15. Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: a decade of discovery – what we have learned and wh ere we are going. J Urol 1999; 162 (2): 293–306.
16. Stamey TA, Yang N, Hay AR et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987; 317: 909–16.
17. Oefelein MG, Smith N, Carter M et al. The incidence of prostate cancer progression with undetectable serum prostate specific antigen in a series of 394 radical prostatectomies. J Urol 1995; 154 (6): 2128–31.
18. Vessella RL. Trends in immunoassays of prostate-specific antigen: serum complexes and ultrasensitivity. Clin Chem1993; 39 (10): 2035–9.
19. Stamey TA, Graves HC, Wehner N et al. Early detection of residual prostate cancer after radical prostatectomy by an ultrasensitive assay for prostate specific antigen. J Urol 1993; 149 (4): 787–92.
20. Ferguson RA, Yu H, Kalyvas M et al. Ultrasensitive detection of prostate-specific antigen by a time-resolved immunofluorometric assay and the Immulite immunochemiluminescent third-generation assay: potential applications in prostate and breast cancers. Clin Chem 1996; 42 (5): 675–84.
21. Ellis WJ, Vessella RL, Noteboom JL et al. Early detection of recurrent prostate cancer with an ultrasensitive hemiluminescent prostate-specific antigen assay. Urology 1997; 50 (4): 573–9.
22. Doherty AP, Bower M, Smitрhetal GL. Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival. Br J Cancer 2000; 83 (11): 1432–6.
23. Sakai I, Harada K, Kurahashi T et al. Usefulness of the nadir value of serum prostate-specific antigen measured by an ultrasensitive assay as a predictor of biochemical recurrence after radical prostatectomy for clinically localized Prostate Cancer Urol Int 2006; 76 (3): 227–31.
24. Shen S, Lepor H, Yaffee R et al. Ultrasensitive serum prostate specific antigen nadir accurately predicts the risk of early relapse after radical prostatectomy. J Urol 2005; 173: 777–80.
25. Vesely S, Jarolim L, Babjuk M et al. Ultrasensitive prostate-specific antigen nadir and time to nadir as independent predictors of biochemical recurrence in patients after radical prostatectomy for localized prostate cancer. Eur Urol 2010; 10 (2): 274.
26. Malik RD, Goldberg JD, Hochman T et al. Three-year postoperative ultrasensitive prostate-specific antigen following open radical retropubic prostatectomy is a predictor for delayed biochemical recurrence. Eur Urol 2011; 60 (3): 19–28.
27. Witherspoon L, Lapeyrolerie T. Sensitive prostates pecific antigen measurements identify men with long disease free intervals and differentiate aggressive from indolent cancer recurrences within 2 years after radical prostatectomy. J Urol 1997; 157 (4): 1322–8.
28. D’Amico AV, Whittington R, Malkowicz SB 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.
29. Eisenberg ML, Davies BJ, Cooperberg MR et al. Prognostic implications of an undetectable ultrasensitive prostate-specific antigen level after radical prostatectomy. Eur Urol 2010; 57 (4): 622–30.
30. Haese A, Huland E, Graefen M et al. Ultrasensitive detection of prostate specific antigen in the followup of 422 patients after radical prostatectomy. J Urol 1999; 161: 1206–11.
31. Taylor JA, Koff SG, Dauser DA et al. The relationship of ultrasensitive measurements of prostate-specific antigen levels to prostate cancer recurrence after radical prostatectomy. BJU Int 2006; 98: 540–3.
Авторы
И.Н.Огнерубова1, И.В.Поддубная1, В.Б.Матвеев2
1 Кафедра онкологии ГБОУ ДПО РМАПО Минздрава РФ, Москва
2 ФГБУ Российский онкологический центр им. Н.Н.Блохина РАМН, Москва