对于初始前列腺特异性抗原（PSA）≤3ng/ml 的男性的“PSA 金字塔”：呼吁个体化前列腺癌筛查。
A "PSA pyramid" for men with initial prostate-specific antigen ≤3 ng/ml: a plea for individualized prostate cancer screening.
机构信息
Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
出版信息
Eur Urol. 2015 Oct;68(4):591-7. doi: 10.1016/j.eururo.2014.04.005. Epub 2014 Apr 18.
BACKGROUND
In daily routine business, various prostate-specific antigen (PSA) retest strategies are being promoted.
OBJECTIVE
To investigate rescreening intervals according to baseline PSA <3 ng/ml stratified by any and aggressive prostate cancer (PCa).
DESIGN, SETTING, AND PARTICIPANTS: From 1998 to 2012, data from 4350 men aged 55-70 yr were analyzed from a population-based prospective screening study (median follow-up: 11.6 yr).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary end point was detection of aggressive PCa (Gleason score 7-10). Cox regression analysis was used to examine the relationship between covariates.
RESULTS AND LIMITATIONS
Baseline PSA of <1.0 ng/ml, 1-1.9 ng/ml, and 2-2.9 ng/ml was present in 2416 men (55.5%: group 1), 1371 men (31.6%: group 2), and 563 men (12.9%: group 3), respectively. Stratified according to these PSA groups, aggressive PCa was detected in 25 patients (1.0%), 80 patients (5.8%), and 34 patients (6.0%), respectively. During 4 yr, these numbers were 0.0%, 0.29%, and 1.8%, whereas during 8 yr, the numbers were 0.2%, 1.4%, and 2.5%, respectively. In multivariable Cox regression analysis, the only independent risk factor for aggressive PCa was baseline PSA (hazard ratio [HR]: 6.06; 95% confidence interval [CI], 3.82-9.61; p<0.0001, group 2 vs group 1; and HR: 7.33; 95% CI, 4.29-12.52; p<0.0001, group 3 vs group 1).
CONCLUSIONS
Baseline PSA was the only predictor regarding aggressive PCa. According to the low rate of potentially missed PCa in these groups, rescreening intervals can be safely adapted to baseline PSA values corresponding to a "PSA pyramid": 6-8 yr if baseline PSA is <1.0 ng/ml, 3-4 yr if baseline PSA is 1-1.99 ng/ml, and yearly if baseline PSA is 2-2.99 ng/ml.
PATIENT SUMMARY
We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value ("PSA pyramid"): PSA <1 (base), retest interval every 8 yr; PSA 1-2 (center), retest interval every 4 yr; and PSA 2-3 (top), retest yearly after risk stratification.
背景
在日常临床工作中，各种前列腺特异性抗原（PSA）复查策略正在被推广。
目的
根据基线 PSA<3ng/ml 对所有和侵袭性前列腺癌（PCa）进行分层，以确定复查间隔。
设计、地点和参与者：本研究基于一项人群基础前瞻性筛查研究（中位随访时间：11.6 年），共纳入了 1998 年至 2012 年间 4350 名年龄在 55-70 岁的男性的数据。
主要结局测量和统计分析
主要终点为检测侵袭性 PCa（Gleason 评分 7-10）。使用 Cox 回归分析来检查协变量之间的关系。
结果和局限性
基线 PSA<1.0ng/ml、1-1.9ng/ml 和 2-2.9ng/ml 的患者分别为 2416 名（55.5%：第 1 组）、1371 名（31.6%：第 2 组）和 563 名（12.9%：第 3 组）。根据这些 PSA 分组，第 1、2 和 3 组分别有 25 例（1.0%）、80 例（5.8%）和 34 例（6.0%）患者被诊断为侵袭性 PCa。在 4 年时，这些数字分别为 0.0%、0.29%和 1.8%，而在 8 年时，这些数字分别为 0.2%、1.4%和 2.5%。多变量 Cox 回归分析显示，侵袭性 PCa 的唯一独立危险因素是基线 PSA（危险比[HR]：6.06；95%置信区间[CI]：3.82-9.61；p<0.0001，第 2 组与第 1 组；和 HR：7.33；95%CI：4.29-12.52；p<0.0001，第 3 组与第 1 组）。
结论
基线 PSA 是唯一与侵袭性 PCa 相关的预测因子。根据这些组中潜在漏诊的 PCa 率较低，复查间隔可根据相应的“PSA 金字塔”调整至基础 PSA 值：如果基线 PSA<1.0ng/ml，则为 6-8 年；如果基线 PSA 在 1.0-1.99ng/ml 之间，则为 3-4 年；如果基线 PSA 在 2.0-2.99ng/ml 之间，则为每年。
患者概况
我们观察了 PSA 值≤3ng/ml 的男性 12 年，发现男性可以根据初始 PSA 值进行复查（“PSA 金字塔”）：PSA<1（基础），每 8 年复查一次；PSA 为 1-2（中心），每 4 年复查一次；PSA 为 2-3（顶部），每年复查一次，然后进行风险分层。
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