Department of Urology, New York University School of Medicine, New York, NY, USA.
BJU Int. 2012 Feb;109(4):508-13; discussion 513-4. doi: 10.1111/j.1464-410X.2011.10900.x. Epub 2012 Feb 1.
• To determine whether the prostate-specific antigen velocity (PSAV) risk count (i.e. the number of times PSAV exceeds a specific threshold) could increase the specificity of screening for prostate cancer and potentially life-threatening tumours.
• From 1989 to 2001, we calculated two serial PSAV measurements in 18 214 prostate cancer screening-study participants, of whom 1125 (6.2%) were diagnosed with prostate cancer. • The PSAV risk count was determined as the number of PSAV measurements of >0.4 ng/mL/year (0, 1, or 2). • We used receiver operating characteristic (ROC) and reclassification analyses to examine the ability of PSAV risk count to predict screen-detected and high-grade prostate cancer.
• The PSAV was >0.4 ng/mL/year twice (risk count 2) in 40% of prostate cancer cases compared with only 4% of those with no cancer (P < 0.001). • After adjusting for age and PSA level, a PSAV risk count of 2 was associated with an 8.2-fold increased risk of prostate cancer (95% confidence interval 7.0-9.6, P < 0.001) and 5.4-fold increased risk of Gleason score 8-10 prostate cancer on biopsy. • Compared with a model with age and PSA level, the addition of the PSAV risk count significantly improved discrimination (area under the ROC curve 0.625 vs 0.725, P= 0.031) and reclassified individuals for the risk of high-grade prostate cancer (net reclassification, P < 0.001).
• Sustained rises in PSA indicate a significantly greater risk of prostate cancer, particularly high-grade disease. • Compared with men with a risk count of ≤1, those with two PSAV measurements of >0.4 ng/mL/year (risk count 2) had an 8-fold increased risk of prostate cancer and 5.4-fold increased risk of Gleason 8-10 disease on biopsy, adjusting for age and PSA level. • Compared to PSA alone, PSAV risk count may be useful in reducing unnecessary biopsies and the diagnosis of low-risk prostate cancer.
1989 年至 2001 年，我们在 18214 名前列腺癌筛查研究参与者中计算了两次连续的 PSAV 测量值，其中 1125 名（6.2%）被诊断为前列腺癌。
PSAV 风险计数确定为 PSAV 测量值>0.4ng/mL/年的次数（0、1 或 2）。
我们使用接受者操作特征（ROC）和再分类分析来检查 PSAV 风险计数预测筛查发现的和高级别前列腺癌的能力。
与无癌症的患者（4%）相比，40%的前列腺癌病例中 PSAV 两次超过 0.4ng/mL/年（风险计数 2）（P<0.001）。
在调整年龄和 PSA 水平后，PSAV 风险计数为 2 与前列腺癌风险增加 8.2 倍（95%置信区间 7.0-9.6，P<0.001）和前列腺癌活检中 Gleason 评分 8-10 风险增加 5.4 倍相关。
与仅包含年龄和 PSA 水平的模型相比，添加 PSAV 风险计数可显著提高区分度（ROC 曲线下面积 0.625 与 0.725，P=0.031）并重新分类高危前列腺癌的个体（净再分类，P<0.001）。
PSA 的持续升高表明前列腺癌的风险显著增加，尤其是高级别疾病。
与风险计数≤1 的男性相比，两次 PSAV 测量值>0.4ng/mL/年（风险计数 2）的男性前列腺癌风险增加 8 倍，前列腺癌活检中 Gleason 8-10 疾病的风险增加 5.4 倍，同时调整了年龄和 PSA 水平。
与 PSA 相比，PSAV 风险计数可能有助于减少不必要的活检和低风险前列腺癌的诊断。
