Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
J Natl Med Assoc. 2011 Feb;103(2):150-7. doi: 10.1016/s0027-9684(15)30264-9.
Delayed evaluation after a clearly abnormal prostate-specific antigen (PSA) result may contribute to more advanced prostate cancer at diagnosis in black men. In 46 primary care practices over a period of 4.5 years, we studied men aged more than 50 years without known prostate cancer who had a PSA of at least 10.0 ng/mL for the first time. PSA follow-up included: a urology appointment, a new prostate diagnosis, or repeat PSA test. Cox proportional hazards models assessed time to follow-up, adjusting for demographic, clinical, and health care factors with censoring at a time that represents excessive delay (200 days). Among all 724 study men (27% black), delay until PSA follow-up averaged 115.2 days (+/- 79.7 d) and the unadjusted hazard ratio (HR) for follow-up was shorter for black men than nonblack men (HR, 1.23; 95% CI, 1.00-1.51). However, black men were more likely to have had prior urology care and had higher index PSA levels than other men; both factors were associated with shorter follow-up. After adjustment, delay did not differ for black vs nonblack race (HR, 1.05; 95% Cl, 0.78-1.43) but men aged at least 75 years had a longer delay than men aged 74 years or less (HR, 0.72; 95% CI, 0.59-0.89). Despite black men having greater risk of advanced prostate disease at diagnosis and better linkage to urologic care, follow-up was delayed, on average, by more than 3 months and did not differ by race. These results reveal a potentially important, remediable factor to improve prostate cancer prevention and care for black men.
在明确异常前列腺特异性抗原（PSA）结果后延迟评估可能导致黑人男性在诊断时患有更晚期的前列腺癌。在 4.5 年的时间里，我们在 46 个初级保健诊所研究了年龄超过 50 岁且首次 PSA 水平至少为 10.0ng/mL 的无已知前列腺癌男性。PSA 随访包括：泌尿科预约、新的前列腺诊断或重复 PSA 检测。Cox 比例风险模型评估了随访时间，调整了人口统计学、临床和医疗保健因素，并在代表过度延迟的时间（200 天）进行了截尾。在所有 724 名研究男性（27%为黑人）中，PSA 随访的平均延迟时间为 115.2 天（+/-79.7 天），未调整的黑人男性随访风险比（HR）低于非黑人男性（HR，1.23；95%CI，1.00-1.51）。然而，黑人男性更有可能接受过先前的泌尿科治疗，且其 PSA 指数水平高于其他男性；这两个因素都与较短的随访时间有关。调整后，黑人与非黑人之间的延迟没有差异（HR，1.05；95%Cl，0.78-1.43），但年龄至少为 75 岁的男性比年龄为 74 岁或以下的男性延迟更长（HR，0.72；95%CI，0.59-0.89）。尽管黑人男性在诊断时患有更晚期前列腺疾病的风险更高，并且与泌尿科治疗的联系更好，但平均而言，随访时间延迟了 3 个多月，而且与种族无关。这些结果揭示了一个潜在的重要、可纠正的因素，可以改善黑人男性的前列腺癌预防和护理。
