Tosoian J J, Alam R, Gergis C, Narang A, Radwan N, Robertson S, McNutt T, Ross A E, Song D Y, DeWeese T L, Tran P T, Walsh P C
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Prostate Cancer Prostatic Dis. 2017 Jun;20(2):193-196. doi: 10.1038/pcan.2016.64. Epub 2017 Jan 3.
To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer.
Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer.
PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96-5.87, P<0.001) as compared to the tested population.
Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.
评估确诊前列腺癌的老年男性的PSA检测史与高危疾病之间的关系。
回顾1993年至2014年期间75岁及以上接受前列腺癌放疗的男性的记录。根据PSA检测史，患者被分为四组之一：（1）未进行PSA检测；（2）PSA检测不完整/无效；（3）进行了PSA检测；或（4）无法确定。感兴趣的结果是美国国立综合癌症网络（NCCN）风险组（即低、中或高风险）以及诊断时的活检分级。采用多变量逻辑回归来确定PSA检测史与高危癌症之间的关联。
290名符合研究标准的受试者中，274名（94.5%）有PSA检测史。总共有148名男性（54.0%）进行了PSA检测并接受了后续活检，72名（26.3%）进行了PSA检测但未进行适当的后续检查，54名男性（19.7%）未进行PSA检测。进行PSA检测的患者被诊断为NCCN高危癌症的可能性显著降低（23.0%对51.6%，P<0.001）。在多变量分析中，与进行检测的人群相比，未进行/PSA检测不完整的男性在诊断时患高危疾病的几率增加了三倍多（优势比3.39，95%置信区间1.96 - 5.87，P<0.001）。
未进行PSA检测或检测不完整的老年男性比之前接受过筛查的男性更有可能被诊断为高危前列腺癌。对于可能从早期检测和治疗中受益的健康老年男性，考虑进行筛查是合理的。
