摘要：

Prostate-specific antigen (PSA) is a valuable tumor marker in the follow-up evaluation of men who have been treated for prostate cancer. An undetectable level of PSA serves as the gold standard for tumor-free status in men after radical prostatectomy.10,12 In 1993, we reported our initial 10-year experience with PSA values after anatomic radical retropubic prostatectomy (RRP) for 955 men with localized disease.12 We now have expanded this series to include 1623 men. In this article we describe the actuarial likelihood of an undetectable PSA level for this group of men who have undergone surgery at The Johns Hopkins Hospital since 1982. We examine the influence of clinical and pathologic parameters, which alone and in combination are shown to have a significant effect on the actuarial rate of PSA recurrence after surgery. In addition, we show that anatomic RRP with preservation of the neurovascular bundles had no adverse effect on cancer control. A Gleason score of at least 8 or involvement of the seminal vesicles or lymph nodes is indicative of eventual failure from distant metastases. We show that in addition to these variables, the timing of the development of a detectable serum PSA also is important in predicting eventual local versus distant failure.

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