前列腺特异性抗原速度（PSAV）风险计数可提高临床显著前列腺癌筛查的特异性。
Prostate-specific antigen velocity (PSAV) risk count improves the specificity of screening for clinically significant prostate cancer.
机构信息
Department of Urology, New York University School of Medicine, New York, NY, USA.
出版信息
BJU Int. 2012 Feb;109(4):508-13; discussion 513-4. doi: 10.1111/j.1464-410X.2011.10900.x. Epub 2012 Feb 1.
OBJECTIVE
• 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.
PATIENTS AND METHODS
• 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.
RESULTS
• 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).
CONCLUSIONS
• 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.
目的
- 确定前列腺特异性抗原速度（PSAV）风险计数（即 PSAV 超过特定阈值的次数）是否可以提高前列腺癌筛查的特异性，并可能提高危及生命的肿瘤的筛查特异性。
患者和方法
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。
结果
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）。
结论
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。
Zotero 插件