Loeb Stacy, Roehl Kimberly A, Catalona William J, Nadler Robert B
Department of Urology, Georgetown University School of Medicine, Washington, DC, USA.
J Urol. 2007 Mar;177(3):899-902. doi: 10.1016/j.juro.2006.10.028.
Longitudinal changes in prostate specific antigen are increasingly used to guide the recommendation for biopsy. Prostate specific antigen velocity 0.75 ng/ml yearly has been proposed to distinguish prostate cancer from benign prostate conditions. However, this threshold might be too high in young men with lower total prostate specific antigen.
In a large prostate cancer screening study 6,844 men were 60 years or younger at study entry and prostate specific antigen velocity calculation was possible. Of these men 346 (5%) were subsequently diagnosed with prostate cancer and various prostate specific antigen velocity thresholds were examined for prediction of prostate cancer risk. Multivariate analysis was performed to determine whether prostate specific antigen velocity is an independent predictor of prostate cancer in men younger than 60 years.
Median prostate specific antigen velocity was significantly higher in men who were later diagnosed with prostate cancer than in those who were not (0.840 vs 0.094 ng/ml yearly, p<0.0001). On multivariate analysis prostate specific antigen velocity greater than 0.4 ng/ml yearly was more predictive of prostate cancer than age, total prostate specific antigen, family history or race. Multivariate analysis in the subgroup of men with total prostate specific antigen less than 2.5 ng/ml had similar results. Overall a cutoff of 0.4 ng/ml yearly was associated with 67.3% sensitivity, 81.2% specificity, 16% positive predictive value and 98% negative predictive value for prostate cancer detection in young men.
The traditional prostate specific antigen velocity threshold of 0.75 ng/ml yearly is too high for men younger than 60 years and it misses 48% of prostate cancers. Young men with prostate specific antigen velocity greater than 0.4 ng/ml yearly are at significantly greater risk for prostate cancer and close followup is warranted.
前列腺特异性抗原的纵向变化越来越多地用于指导活检建议。有人提出每年前列腺特异性抗原速度为0.75 ng/ml可用于区分前列腺癌和良性前列腺疾病。然而，对于总前列腺特异性抗原较低的年轻男性，这个阈值可能过高。
在一项大型前列腺癌筛查研究中，6844名男性在研究开始时年龄为60岁或以下，且能够计算前列腺特异性抗原速度。在这些男性中，346名（5%）随后被诊断为前列腺癌，并对各种前列腺特异性抗原速度阈值进行了检测，以预测前列腺癌风险。进行多变量分析以确定前列腺特异性抗原速度是否是60岁以下男性前列腺癌的独立预测因素。
后来被诊断为前列腺癌的男性的前列腺特异性抗原速度中位数显著高于未患前列腺癌的男性（每年0.840 vs 0.094 ng/ml，p<0.0001）。多变量分析显示，每年前列腺特异性抗原速度大于0.4 ng/ml比年龄、总前列腺特异性抗原、家族史或种族更能预测前列腺癌。对总前列腺特异性抗原小于2.5 ng/ml的男性亚组进行的多变量分析也有类似结果。总体而言，每年0.4 ng/ml的临界值在年轻男性前列腺癌检测中的灵敏度为67.3%，特异度为81.2%，阳性预测值为16%，阴性预测值为98%。
传统的每年0.75 ng/ml的前列腺特异性抗原速度阈值对于60岁以下男性过高，会漏诊48%的前列腺癌。每年前列腺特异性抗原速度大于0.4 ng/ml的年轻男性患前列腺癌的风险显著更高，有必要进行密切随访。
