Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York; Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York.
Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York; Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York.
J Urol. 2017 Apr;197(4):1014-1019. doi: 10.1016/j.juro.2016.11.002. Epub 2016 Nov 8.
To our knowledge the optimal treatment of patients following a negative prostate biopsy is unknown. Consequently, resources are increasingly being directed toward risk stratification in this cohort. However, the risk of prostate cancer mortality in this group before the introduction of supplemental biomarkers and imaging techniques is unclear.
The PLCO (Prostate, Lung, Colorectal and Ovarian Cancer) Screening Trial provides survival data prior to the implementation of new diagnostic interventions. We divided men with an initial positive screen and a subsequent prostate biopsy into cohorts based on positive or negative results. Prostate cancer specific mortality was then compared to that in the trial control arm to estimate the prognostic significance of biopsy results relative to the general population.
A total of 36,525 and 36,560 patients comprised the screening and control arms, respectively. Of 4,064 subjects with a positive first screen 1,233 underwent a linked biopsy, of which 473 were positive and 760 were negative. At a median followup of 12.9 years, 1.1% of men in the negative biopsy cohort had died of prostate cancer. The difference in mortality rates between the negative biopsy and control arms was 0.734 deaths per 1,000 person-years. The proportional subhazard ratios of prostate cancer specific mortality for negative biopsy and positive biopsy relative to the control arm were 2.93 (95% CI 1.44-5.99) and 18.77 (95% CI 12.62-27.93), respectively.
After a negative prostate biopsy, men face a relatively low risk of death from prostate cancer when followed with traditional markers and biopsy techniques. This suggests limited potential for new diagnostic interventions to improve survival in this group.
据我们所知，对于前列腺活检阴性患者的最佳治疗方法尚不清楚。因此，在这一人群中，资源越来越多地被用于风险分层。然而，在引入补充生物标志物和成像技术之前，这一组人群的前列腺癌死亡率风险尚不清楚。
PLCO（前列腺癌、肺癌、结直肠癌和卵巢癌）筛查试验提供了新诊断干预措施实施前的生存数据。我们根据初始阳性筛查和随后的前列腺活检结果将男性患者分为阳性或阴性两组。然后将前列腺癌特异性死亡率与试验对照组进行比较，以估计活检结果相对于一般人群的预后意义。
共有 36525 名和 36560 名患者分别纳入筛查组和对照组。在 4064 名初次阳性筛查的患者中，有 1233 名接受了相关的活检，其中 473 例为阳性，760 例为阴性。在中位随访 12.9 年后，阴性活检组中有 1.1%的男性死于前列腺癌。阴性活检组和对照组之间的死亡率差异为每 1000 人年 0.734 例死亡。阴性活检和阳性活检相对于对照组的前列腺癌特异性死亡率的比例亚危险比分别为 2.93（95%CI 1.44-5.99）和 18.77（95%CI 12.62-27.93）。
在进行前列腺活检阴性后，男性在采用传统标志物和活检技术进行随访时，面临相对较低的前列腺癌死亡风险。这表明新的诊断干预措施在这一人群中提高生存率的潜力有限。
