Department of Urology, Medical University of Vienna, Vienna, Austria.
World J Urol. 2012 Jun;30(3):405-10. doi: 10.1007/s00345-011-0749-1. Epub 2011 Aug 30.
We evaluated the impact of age on PCA3 score and the utility of age-specific reference values in predicting initial prostate biopsy (pBx) outcomes.
This single-center, retrospective study included 205 men who underwent an initial 14-core TRUS-guided pBx due to PSA > 3.0 ng/ml or suspicious digital-rectal examination (DRE). PCA3 scores were measured with the Progensa assay. Linear regression models were fit to identify factors that impact PCA3 score and to determine age-specific reference values. Predictive accuracies of logistic regression models predicting presence of prostate cancer (PCa) were analyzed.
The positive biopsy rate was 37%. In multivariable linear regression, age (P < 0.001), presence of PCa (P < 0.001), and multifocal HG-PIN (P = 0.012) were independent predictors of PCA3 score. Age showed the strongest impact on PCA3 score (T = 4.77). The upper 95% confidence interval of PCA3 score in each age category was defined as the age-specific limit. A PCA3-score over the age-specific limit (PCA3-age) was associated with an 4.17-fold increased odds of being diagnosed with PCa (P < 0.001). In multivariable logistic regression models predicting the presence of PCa, predictive accuracy of a base model (age, DRE, PSA, volume) increased from 69.6 to 75.4% (P = 0.037) by adding the continuous PCA3 score, to 73.9% (P = 0.098) with the 35 cutoff (PCA3-35) and to 77.1% (P = 0.008) with PCA3-age.
PCA3 score increases with age, independent of PCa presence. Age-specific PCA3 score reference values are superior to PSA, continuous PCA3 score, and PCA3-35 in predicting initial pBx outcome. Therefore, an age-adjusted PCA3 score should be used for interpretation of the results.
我们评估了年龄对 PCA3 评分的影响，以及年龄特异性参考值在预测初始前列腺活检（pBx）结果中的效用。
这项单中心、回顾性研究纳入了 205 名因 PSA>3.0ng/ml 或可疑直肠指诊（DRE）而接受初始 14 核经直肠超声引导下 pBx 的男性。使用 Progensa 检测试剂盒测量 PCA3 评分。拟合线性回归模型以确定影响 PCA3 评分的因素，并确定年龄特异性参考值。分析了预测存在前列腺癌（PCa）的逻辑回归模型的预测准确性。
阳性活检率为 37%。在多变量线性回归中，年龄（P<0.001）、PCa 存在（P<0.001）和多灶性高级别前列腺上皮内瘤变（HG-PIN）（P=0.012）是 PCA3 评分的独立预测因子。年龄对 PCA3 评分的影响最大（T=4.77）。每个年龄组 PCA3 评分的上 95%置信区间被定义为年龄特异性限值。超过年龄特异性限值的 PCA3 评分（PCA3-age）与被诊断为 PCa 的几率增加 4.17 倍相关（P<0.001）。在预测 PCa 存在的多变量逻辑回归模型中，通过加入连续 PCA3 评分，基本模型（年龄、DRE、PSA、体积）的预测准确性从 69.6%提高到 75.4%（P=0.037），使用 35 截断值（PCA3-35）提高到 73.9%（P=0.098），使用 PCA3-age 提高到 77.1%（P=0.008）。
PCA3 评分随年龄增长而增加，与 PCa 存在无关。年龄特异性 PCA3 评分参考值在预测初始 pBx 结果方面优于 PSA、连续 PCA3 评分和 PCA3-35。因此，应使用年龄调整的 PCA3 评分来解释结果。
