Division of Urology, Department of Surgery and Duke Prostate Center, Duke University Medical Center, Durham, NC, USA.
BJU Int. 2011 Jul;108(1):44-8. doi: 10.1111/j.1464-410X.2010.09812.x. Epub 2010 Nov 2.
• To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.
• The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. • The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan-Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff.
• On multivariate analysis, men with a PSA velocity of PSA velocity ≥ 0.45 ng/mL/year had a 4.8-fold higher risk of death from PCa as compared to men with a PSA velocity of < 0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow-up from diagnosis, 1.4% of the men with a PSA velocity < 0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥ 0.45 ng/mL/year. • The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001).
• Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.
评估前列腺特异性抗原（PSA）速度是否可用于分层前列腺癌（PCa）死亡风险患者，并有助于为老年男性的 PSA 筛查决策提供依据，因为之前的研究表明 PSA 速度可以预测 PCa 风险。
该队列纳入了 3525 名年龄≥75 岁且在诊断为 PCa 之前进行了两次或以上 PSA 检测的患者。使用 Cox 比例风险模型评估在最后一次 PSA 测量时与 PCa 死亡相关的变量。计算不同 PSA 速度组在诊断后的 PCa 死亡率。Kaplan-Meier 和对数秩检验用于评估按 PSA 速度截止值分层的诊断后 PCa 死亡的显著差异。
在多变量分析中，与 PSA 速度<0.45ng/mL/年的男性相比，PSA 速度≥0.45ng/mL/年的男性诊断后死于 PCa 的风险高 4.8 倍（p 值=0.013）。在诊断后中位随访 6.5 年（最长 16.9 年）期间，PSA 速度<0.45ng/mL/年的男性中有 1.4%死于 PCa，而 PSA 速度≥0.45ng/mL/年的男性中有 8.7%死于 PCa。按 PSA 速度 0.45ng/mL/年分层，诊断后 PCa 死亡的累积率存在统计学差异（对数秩检验，P<0.001）。
年龄≥75 岁且 PSA 速度<0.45ng/mL/年的男性不太可能死于 PCa。这些男性可能可以安全地停止 PSA 筛查。
