Ankerst Donna Pauler, Miyamoto Ryan, Nair Prakash Vijay, Pollock Brad H, Thompson Ian M, Parekh Dipen J
Depatment of Urology, University of Texas Health Sciences Center, San Antonio, Texas, USA.
J Urol. 2009 May;181(5):2071-5; discussion 2076. doi: 10.1016/j.juro.2009.01.029. Epub 2009 Mar 14.
Prostate biopsy is often recommended based on increases in prostate specific antigen and/or abnormal digital rectal examination. We investigated the stability of a single positive test during the next 3 consecutive years.
A total of 2,578 participants in a San Antonio screening cohort with 2 or more consecutive annual prostate specific antigen and digital rectal examination tests were identified. Occurrences of an increased prostate specific antigen (2.5 ng/ml or greater) followed by 1 or more nonincreased prostate specific antigen results were compared with similar fluctuations of digital rectal examination from abnormal to normal.
In 2,272 men who did not have a biopsy during the study, in 23.3% of 744 incidences of an increased prostate specific antigen with 1 year of followup, the next prostate specific antigen was not increased. In 19.5% of 462 incidences of an increased prostate specific antigen with 2 years of followup, the next 2 consecutive prostate specific antigen levels were not increased. Finally, in 17.5% of 285 incidences of an increased prostate specific antigen with 3 years of followup, the next 3 consecutive prostate specific antigens were not increased. Rates were similar but lower in 221 men with 1 or more negative biopsies during the study and in 85 men in whom prostate cancer eventually developed during the study. In contrast, approximately 70% of abnormal digital rectal examinations were normal the following year even in patients with prostate cancer, and in the majority of incidences remained normal the next 2 to 3 consecutive years.
Occurrences of reversed prostate specific antigen cut point or abnormal digital rectal examination based decisions to biopsy 1 or more years after the initial test are not uncommon, suggesting repetition of these tests.
基于前列腺特异性抗原升高和/或直肠指检异常，常建议进行前列腺活检。我们研究了单次阳性检测在接下来连续3年中的稳定性。
在圣安东尼奥筛查队列中，共确定了2578名参与者，他们进行了连续2次或更多次年度前列腺特异性抗原检测和直肠指检。将前列腺特异性抗原升高（2.5 ng/ml或更高）后出现1次或更多次前列腺特异性抗原未升高的情况，与直肠指检从异常到正常的类似波动情况进行比较。
在研究期间未进行活检的2272名男性中，在744例前列腺特异性抗原升高且随访1年的病例中，23.3%的患者下一次前列腺特异性抗原未升高。在462例前列腺特异性抗原升高且随访2年的病例中，19.5%的患者接下来连续2次前列腺特异性抗原水平未升高。最后，在285例前列腺特异性抗原升高且随访3年的病例中，17.5%的患者接下来连续3次前列腺特异性抗原未升高。在研究期间有1次或更多次活检阴性的221名男性以及研究期间最终患前列腺癌的85名男性中，发生率相似但较低。相比之下，即使是前列腺癌患者，约70%的直肠指检异常在次年恢复正常，并且在大多数情况下，接下来连续2至3年仍保持正常。
基于前列腺特异性抗原切点逆转或直肠指检异常在初次检测1年或更长时间后决定进行活检的情况并不少见，这表明需要重复这些检测。
