Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX 78229, USA; Department of Urology, UTHSCSA, San Antonio, TX 78229, USA; School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Cancer Therapy and Research Center, UTHSCSA, San Antonio, TX 78229, USA.
Urol Oncol. 2013 Oct;31(7):1085-92. doi: 10.1016/j.urolonc.2011.12.023. Epub 2012 Feb 3.
To evaluate factors affecting the risk of prostate cancer (CaP) and high-grade disease (HGCaP, Gleason score ≥ 7) in a Mexican referral population, with comparison to the Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator (PCPTRC).
From a retrospective study of 826 patients who underwent prostate biopsy between January 2005 and December 2009 at the Instituto Nacional de Cancerología, Mexico, logistic regression was used to assess the effects of age, prostate-specific antigen (PSA), digital rectal exam (DRE), first-degree family history of CaP, and history of a prior prostate biopsy on CaP and HGCaP, separately. Internal discrimination, goodness-of-fit, and clinical utility of the resulting models were assessed with comparison to the PCPTRC.
Rates of both CaP (73.2%) and HGCaP (33.3%) were high among referral patients in this Mexican urology clinic. The PCPTRC generally underestimated the risk of CaP but overestimated the risk of HGCaP. Four factors influencing CaP on biopsy were logPSA, DRE, family history and a prior biopsy history (all P < 0.001). The internal AUC of the logistic model was 0.823 compared with 0.785 of the PCPTRC for CaP (P < 0.001). The same 4 factors were significantly associated with HGCaP as well and the AUC was 0.779 compared with 0.766 of the PCPTRC for HGCaP (P = 0.13).
Lack of screening programs or regular urologic checkups in Mexico imply that men typically first reach specialized clinics with a high cancer risk. This renders diagnostic tools developed on comparatively healthy populations, such as the PCPTRC, of lesser utility. Continued efforts are needed to develop and externally validate new clinical diagnostic tools specific to high-risk referral populations incorporating new biomarkers and more clinical characteristics.
评估影响前列腺癌（CaP）和高级别疾病（HGCaP，Gleason 评分≥7）风险的因素，该研究纳入了墨西哥一家转诊人群，并与前列腺癌预防试验前列腺癌风险计算器（PCPTRC）进行了比较。
本研究回顾性分析了 2005 年 1 月至 2009 年 12 月在墨西哥国家癌症研究所接受前列腺活检的 826 例患者的资料，采用 logistic 回归分析评估年龄、前列腺特异性抗原（PSA）、直肠指检（DRE）、一级亲属 CaP 病史和既往前列腺活检史对 CaP 和 HGCaP 的影响，分别进行分析。通过与 PCPTRC 比较，评估了由此产生的模型的内部区分度、拟合优度和临床实用性。
在这家墨西哥泌尿科诊所，转诊患者的 CaP（73.2%）和 HGCaP（33.3%）发生率均较高。PCPTRC 通常低估了 CaP 的风险，但高估了 HGCaP 的风险。4 个因素（logPSA、DRE、家族史和既往活检史）影响活检时的 CaP（均 P<0.001）。logistic 模型的内部 AUC 为 0.823，而 PCPTRC 为 0.785（P<0.001）。同样的 4 个因素也与 HGCaP 显著相关，AUC 为 0.779，而 PCPTRC 为 0.766（P=0.13）。
墨西哥缺乏筛查计划或定期泌尿科检查，这意味着男性通常首先到达癌症风险较高的专科诊所。这使得基于相对健康人群（如 PCPTRC）开发的诊断工具的实用性降低。需要继续努力，开发和外部验证专门针对高风险转诊人群的新临床诊断工具，纳入新的生物标志物和更多的临床特征。
