Schwartz Michael J, Hwang David H, Hung Andrew J, Han Jullet, McClain Justin W, Shemtov M Mendel, Te Alexis E, Sosa R Ernest, Vaughan E Darracott, Scherr Douglas S
Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Cancer. 2008 Apr 15;112(8):1718-25. doi: 10.1002/cncr.23353.
A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era.
Of 3634 prostate biopsies performed from 1993-2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time-cohorts (1993-1997, 1998-2001, and 2002-2005) to assess for practice patterns shifts and correlation between PSA and biopsy results.
Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5-3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993-1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE.
Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high-grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0-4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection.
在活检实践模式与如今不同的时代，前列腺特异性抗原（PSA）水平与前列腺活检阳性率之间建立了相关性。我们评估了活检实践模式的变化是否影响了PSA在当前时代预测前列腺活检癌症检出的能力。
在1993年至2005年进行的3634例前列腺活检中，1607例符合分析标准。活检数据被分为3个时间队列（1993 - 1997年、1998 - 2001年和2002 - 2005年），以评估实践模式的变化以及PSA与活检结果之间的相关性。
活检实践模式的显著变化包括活检针数增加以及更频繁地将PSA 2.5 - 3.99 ng/mL用作活检指征。在直肠指检（DRE）正常的男性中，1993年至1997年PSA与活检阳性率之间确实存在中度相关性，但随后消失。多因素分析显示，在DRE正常的男性中，PSA不是活检结果的显著预测因素。
在PSA时代早期，PSA的预测能力取决于多个因素：疾病的高患病率、高级别疾病的较高患病率以及PSA水平低的男性前列腺癌诊断的低可能性。现在，除了活检发生率增加的筛选作用以及活检实践模式的转变外，DRE正常的男性中PSA与活检结果之间的相关性已丧失。在PSA为2.0 - 4.0 ng/mL的男性中诊断出更高比例的肿瘤对PSA检测癌症的预测价值产生了负面影响。
