Division of Urology, Department of Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cancer. 2010 Oct 15;116(20):4711-7. doi: 10.1002/cncr.25447.
A diagnosis of prostate cancer is not often predictive of death from prostate cancer because of competing causes of mortality. Identification of the risk of death from prostate cancer and death from all causes using information available at the time of baseline prostate-specific antigen (PSA) measurement appears to be particularly pertinent.
The Duke Prostate Center database was used to identify men who had their PSA level measured over the past 20 years. The Cox proportional hazards model was used to assess whether baseline PSA, race, and age at baseline PSA could predict death from prostate cancer and death from all causes after baseline PSA measurement. The receiver operating characteristic (ROC) curve was performed to analyze the accuracy of baseline PSA as a continuous variable in predicting death from prostate cancer.
A total of 4568 men diagnosed with prostate cancer after baseline PSA measurement were included. On multivariate analysis, baseline PSA levels of 4.0 to 9.9 ng/mL and ≥10 ng/mL were associated with significantly higher rates of death from prostate cancer compared with PSA levels <2.5 ng/mL. An advanced age at baseline PSA and African American race were associated with a higher death rate from prostate cancer and death from all causes. The area under the ROC curve for baseline PSA predicting death was 0.839. When a baseline PSA of 10 ng/mL was chosen to predict death from prostate cancer, the corresponding sensitivity and specificity were 77% and of 78%, respectively.
Baseline PSA appears to be a reliable and independent predictor of death from prostate cancer. A baseline PSA of ≥4 ng/mL has been associated with higher risk of death from prostate cancer.
由于存在其他致死原因，前列腺癌的诊断通常并不能预测前列腺癌相关的死亡。使用基线前列腺特异性抗原（PSA）检测时获得的信息，识别前列腺癌死亡风险和全因死亡风险似乎尤为重要。
利用杜克前列腺中心数据库，确定了过去 20 年期间检测过 PSA 水平的男性。使用 Cox 比例风险模型评估基线 PSA、种族和基线 PSA 年龄是否可以预测基线 PSA 检测后前列腺癌死亡和全因死亡。绘制受试者工作特征（ROC）曲线，分析基线 PSA 作为连续变量预测前列腺癌死亡的准确性。
共纳入 4568 例基线 PSA 检测后诊断为前列腺癌的男性。多变量分析显示，与 PSA＜2.5ng/ml 相比，基线 PSA 水平在 4.0-9.9ng/ml 和≥10ng/ml 与前列腺癌死亡率显著升高相关。基线 PSA 年龄较大和非裔美国人种族与前列腺癌和全因死亡率升高相关。ROC 曲线下面积显示，基线 PSA 预测前列腺癌死亡的 AUC 为 0.839。当选择基线 PSA 为 10ng/ml 预测前列腺癌死亡时，相应的敏感性和特异性分别为 77%和 78%。
基线 PSA 似乎是前列腺癌死亡的可靠且独立的预测指标。基线 PSA≥4ng/ml 与前列腺癌死亡风险增加相关。
