Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA.
Department of Medicine, University of New Mexico, New Mexico VA Health Care System, Albuquerque, NM.
Urology. 2014 Mar;83(3):599-605. doi: 10.1016/j.urology.2013.10.051. Epub 2014 Jan 16.
To determine the distribution of screening prostate-specific antigen (PSA) values in older men, and how different PSA thresholds affect the proportion of white, black, and Latino men who would have an abnormal screening result across advancing age groups.
We used linked national Veterans Affairs and Medicare data to determine the value of the first screening PSA test (ng/mL) of 327,284 men older than 65 years who underwent PSA screening in the Veterans Affairs health care system in 2003. We calculated the proportion of men with an abnormal PSA result based on age, race, and common PSA thresholds.
Among men older than 65 years, 8.4% had a PSA >4.0 ng/mL. The percentage of men with a PSA >4.0 ng/mL increased with age and was highest in black men (13.8%) vs white (8.0%) or Latino men (10.0%) (P <.001). Combining age and race, the probability of having a PSA >4.0 ng/mL ranged from 5.1% of Latino men aged 65-69 years to 27.4% of black men older than 85 years. Raising the PSA threshold from >4.0 ng/mL to >10.0 ng/mL reclassified the greatest percentage of black men older than 85 years (18.3% absolute change) and the lowest percentage of Latino men aged 65-69 years (4.8% absolute change) as being under the biopsy threshold (P <.001).
Age, race, and PSA threshold together affect the pretest probability of an abnormal screening PSA result. Based on screening PSA distributions, stopping screening among men whose PSA <3 ng/mL means more than 80% of white and Latino men older than 70 years would stop further screening, and increasing the biopsy threshold to >10 ng/mL has the greatest effect on reducing the number of older black men who will face biopsy decisions after screening.
确定老年男性前列腺特异性抗原（PSA）筛查值的分布情况，以及不同 PSA 阈值如何影响不同种族男性（白人、黑人、拉丁裔）在各年龄段异常筛查结果的比例。
我们使用退伍军人事务部（VA）和医疗保险（Medicare）的全国性关联数据，确定了 2003 年在 VA 医疗系统中接受 PSA 筛查的 327284 名年龄超过 65 岁男性的首次 PSA 筛查值（ng/ml）。我们根据年龄、种族和常见 PSA 阈值计算了异常 PSA 结果的男性比例。
在年龄超过 65 岁的男性中，有 8.4%的 PSA 值>4.0ng/ml。随着年龄的增长，PSA 值>4.0ng/ml 的男性比例逐渐增加，且黑人男性（13.8%）高于白人（8.0%）或拉丁裔男性（10.0%）（P<.001）。综合年龄和种族因素，PSA 值>4.0ng/ml 的概率从 65-69 岁的拉丁裔男性的 5.1%到 85 岁以上的黑人男性的 27.4%不等。将 PSA 阈值从>4.0ng/ml 提高到>10.0ng/ml，将 85 岁以上的黑人男性中最大比例（18.3%的绝对变化）重新归类为处于活检阈值以下，而将 65-69 岁的拉丁裔男性中最小比例（4.8%的绝对变化）重新归类为处于活检阈值以下（P<.001）。
年龄、种族和 PSA 阈值共同影响异常 PSA 筛查结果的术前概率。基于 PSA 筛查分布情况，如果将 PSA 值<3ng/ml 的男性停止进一步筛查，那么超过 80%的 70 岁以上的白人及拉丁裔男性将不再进行筛查，而将活检阈值提高到>10ng/ml 将对减少接受筛查后的黑人老年男性数量产生最大影响，他们将面临活检决策。
