总前列腺特异性抗原低于4 ng/ml的男性的前列腺特异性抗原速率

Prostate specific antigen velocity in men with total prostate specific antigen less than 4 ng/ml.

作者信息

Loeb Stacy, Roehl Kimberly A, Nadler Robert B, Yu Xiaoying, Catalona William J

机构信息

Department of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

J Urol. 2007 Dec;178(6):2348-52; discussion 2352-3. doi: 10.1016/j.juro.2007.08.016. Epub 2007 Oct 22.

DOI:10.1016/j.juro.2007.08.016

PMID:17936844

Abstract

PURPOSE

A prostate specific antigen velocity threshold of 0.75 ng/ml per year has commonly been used to distinguish men with prostate cancer from those with benign prostate conditions. In addition, a prostate specific antigen velocity greater than 2 ng/ml per year has been linked to an increased prostate cancer specific mortality rate after radical prostatectomy and after radiation therapy. However, both of these frequently cited thresholds were determined largely in groups of men with a prostate specific antigen greater than 4 ng/ml.

MATERIALS AND METHODS

Of approximately 26,000 men who participated in a prostate cancer screening study 22,019 had a prostate specific antigen of 4 ng/ml or less. Of these men 501 were diagnosed with prostate cancer and had sufficient data for a prostate specific antigen velocity calculation. We performed univariate and multivariate analyses to compare cancer detection rates and performance characteristics using various prostate specific antigen velocity thresholds in these men.

RESULTS

In men with a prostate specific antigen less than 4 ng/ml, a prostate specific antigen velocity threshold of 0.4 ng/ml per year was most useful for recommending prostate biopsy. Overall prostate cancer was diagnosed in 223 (2%) men with a prostate specific antigen velocity less than 0.4 ng/ml per year compared to 278 (13%) men with a prostate specific antigen velocity greater than 0.4 ng/ml per year (p <0.0001). On multivariate analysis a prostate specific antigen velocity greater than 0.4 ng/ml per year was a stronger independent predictor of prostate cancer diagnosis than age, race or a family history of prostate cancer.

CONCLUSIONS

The traditional prostate specific antigen threshold of 0.75 ng/ml per year was determined largely in men with a total prostate specific antigen of 4 to 10 ng/ml. Prostate specific antigen velocity thresholds in the range of 0.4 ng/ml per year should be used to help guide the need for biopsy in men with a total prostate specific antigen less than 4 ng/ml.

摘要

目的

每年0.75 ng/ml的前列腺特异性抗原速度阈值通常用于区分前列腺癌患者与良性前列腺疾病患者。此外，每年大于2 ng/ml的前列腺特异性抗原速度与前列腺癌根治术后及放疗后的前列腺癌特异性死亡率增加有关。然而，这两个经常被引用的阈值在很大程度上是在前列腺特异性抗原大于4 ng/ml的男性群体中确定的。

材料与方法

在参与前列腺癌筛查研究的约26000名男性中，22019名男性的前列腺特异性抗原为4 ng/ml或更低。在这些男性中，501名被诊断为前列腺癌，并有足够的数据进行前列腺特异性抗原速度计算。我们进行了单变量和多变量分析，以比较这些男性使用各种前列腺特异性抗原速度阈值时的癌症检出率和性能特征。

结果

在前列腺特异性抗原小于4 ng/ml的男性中，每年0.4 ng/ml的前列腺特异性抗原速度阈值对推荐前列腺活检最有用。每年前列腺特异性抗原速度小于0.4 ng/ml的223名（2%）男性被诊断为前列腺癌，而每年前列腺特异性抗原速度大于0.4 ng/ml的278名（13%）男性被诊断为前列腺癌（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是比年龄、种族或前列腺癌家族史更强的前列腺癌诊断独立预测因素。