Canby-Hagino Edith, Hernandez Javier, Brand Timothy C, Troyer Dean A, Higgins Betsy, Ankerst Donna Pauler, Thompson Ian M, Leach Robin J, Parekh Dipen J
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Urology. 2007 Oct;70(4):748-52. doi: 10.1016/j.urology.2007.06.1105.
Family history has been identified as a risk factor for prostate cancer. We assessed the risk of prostate cancer in men with a positive family history (at least one first-degree or second-degree relative), normal digital rectal examination (DRE) and a serum prostate-specific antigen (PSA) level of 4.0 ng/mL.
A total of 87 volunteers from the San Antonio Center of biomarkers of risk for prostate cancer study enrolled in a prospective study to assess the prevalence of prostate cancer in men with a family history of prostate cancer, normal DRE findings, and a serum PSA level of 4.0 ng/mL or less. All subjects underwent transrectal ultrasound-guided prostate biopsy.
Prostate cancer was diagnosed in 22 (25.3%) of the 87 participants. The PSA values were significantly greater statistically in the men with prostate cancer (median 2.1 ng/mL) than in the men without prostate cancer (median 1.2 ng/mL, P = 0.01), and the odds of prostate cancer nearly doubled for a doubling of the PSA level within this interval (odds ratio 1.97, P = 0.02). No statistically significant difference was found in age, race, or number and type of affected relatives in men with and without prostate cancer.
The results of our study have demonstrated a high frequency of prostate cancer in men with a positive family history but normal DRE findings and a PSA level of 4.0 ng/mL or less. These prospectively collected data raise an important consideration regarding lowering the PSA cutoff values for offering biopsy in patients with a positive family history and normal DRE findings.
家族史已被确定为前列腺癌的一个风险因素。我们评估了家族史阳性(至少有一位一级或二级亲属)、直肠指检(DRE)正常且血清前列腺特异性抗原(PSA)水平为4.0 ng/mL的男性患前列腺癌的风险。
来自圣安东尼奥前列腺癌风险生物标志物中心的87名志愿者参与了一项前瞻性研究,以评估有前列腺癌家族史、DRE检查结果正常且血清PSA水平为4.0 ng/mL或更低的男性中前列腺癌的患病率。所有受试者均接受经直肠超声引导下的前列腺活检。
87名参与者中有22人(25.3%)被诊断为前列腺癌。前列腺癌患者的PSA值在统计学上显著高于无前列腺癌患者(中位数2.1 ng/mL)(无前列腺癌患者中位数为1.2 ng/mL,P = 0.01),在此区间内PSA水平每翻倍,患前列腺癌的几率几乎翻倍(比值比1.97,P = 0.02)。在有前列腺癌和无前列腺癌的男性中,年龄、种族或受影响亲属的数量和类型在统计学上无显著差异。
我们的研究结果表明,家族史阳性但DRE检查结果正常且PSA水平为4.0 ng/mL或更低的男性中前列腺癌的发生率很高。这些前瞻性收集的数据引发了一个重要的思考,即对于家族史阳性且DRE检查结果正常的患者,是否应降低PSA临界值以进行活检。