Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
BMJ. 2013 Apr 15;346:f2023. doi: 10.1136/bmj.f2023.
To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified.
Case-control study with 1:3 matching nested within a highly representative population based cohort study.
Malmö Preventive Project, Sweden.
21,277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years.
Metastasis or death from prostate cancer ascertained by review of case notes.
Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (≥ 1.6 µg/L), with a similar proportion for the highest 10th at age 51-55 (≥ 2.4 µg/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 µg/L) or 51-55 (0.85 µg/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group.
Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.
在未筛查人群中，确定 40-55 岁时前列腺特异性抗原（PSA）浓度与前列腺癌转移和死亡风险之间的关联，以评估何时开始筛查前列腺癌，以及是否可以根据风险进行重新筛查。
病例对照研究，在一个基于代表性人群的队列研究中进行 1:3 匹配嵌套。
瑞典马尔默预防项目。
21277 名年龄在 27-52 岁的瑞典男性（合格人群的 74%），他们在 1974-84 年基线时提供了血液样本，4922 名男性被邀请在六年后提供第二份样本。在中位随访 27 年期间，PSA 检测率仍然极低。
通过病历审查确定前列腺癌转移或死亡的情况。
死亡风险与基线 PSA 相关：45-49 岁时 PSA 浓度分布最高的第 10 个百分位数（≥1.6μg/L）的男性中，44%（95%置信区间 34%至 53%）的死亡归因于前列腺癌，51-55 岁时 PSA 浓度分布最高的第 10 个百分位数（≥2.4μg/L：44%，32%至 56%）也有类似的比例。尽管在 45-49 岁时 PSA 浓度低于中位数（0.68μg/L）或 51-55 岁时（0.85μg/L），不能排除 25-30 年的前列腺癌转移风险，但在 45-49 岁时，15 年的风险仍然较低，为 0.09%（0.03%至 0.23%），51-55 岁时为 0.28%（0.11%至 0.66%），这表明在该组中，筛查间隔时间更长可能更为合适。
在中年早期测量 PSA 浓度可以识别出几十年后前列腺癌转移风险增加的一小部分男性。这些男性需要进行仔细监测。鉴于目前关于 60 岁时 PSA 浓度与死亡风险的数据，这些结果表明，对于至少一半的男性来说，三次终生 PSA 检测（40 多岁中期、50 多岁早期和 60 岁）可能就足够了。
