Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Eur Urol Focus. 2019 Sep;5(5):842-848. doi: 10.1016/j.euf.2018.02.001. Epub 2018 Feb 9.
Although prostate-specific antigen (PSA) testing is common, little is known about the pattern of retesting by either PSA values or subsequent prostate biopsies. Poor follow-up of high PSA values may lead to delayed diagnosis.
To estimate the probabilities of follow-up (including retesting, prostate biopsies, diagnosis, and cause-specific death) for men undergoing prostate cancer testing at a population level.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study design for men living in Stockholm with no previous diagnosis of prostate cancer between 2003 and 2015. Men were linked to the national health and population registries in Sweden. We report follow-up for men aged 50-79 yr at 2003 or at their index PSA test.
State probabilities with 95% confidence intervals (CIs) were calculated using multistate Markov models.
Among men not previously diagnosed with prostate cancer with an initial PSA value of ≥10ng/ml, the proportions at 1 yr with no subsequent testing or only elevated PSA test values >3ng/ml were 21.7% (95% CI: 19.5, 23.9), 25.2% (95% CI: 23.9, 26.6), and 47.7% (95% CI: 46.2, 49.1) for those aged 50-59, 60-69, and 70-79 yr, respectively. No significant changes were noticed when stratifying by comorbidities. Limitations include the lack of detail from patient medical charts. This detail would have allowed for more accurate assessment of appropriate clinical follow-up.
Regardless of medical history, a large proportion of men with PSA≥10ng/ml were not followed appropriately at 1 yr after the index PSA test. This may partially explain why opportunistic testing is not as effective as screening within trials to reduce prostate cancer mortality.
For men aged 50-69 yr, who undertake a prostate-specific antigen (PSA) test, a PSA level of >10ng/ml should prompt further investigation. However, we found that one out of 10 of these men did not receive repeat testing within 1 yr of the initial test. This may partially explain why opportunistic prostate cancer testing is less effective than screening trials.
尽管前列腺特异性抗原（PSA）检测很常见，但人们对 PSA 值或随后的前列腺活检的复查模式知之甚少。对高 PSA 值的随访不佳可能导致诊断延迟。
估计在人群水平上进行前列腺癌检测的男性的随访（包括复查、前列腺活检、诊断和特定原因死亡）的概率。
设计、地点和参与者：2003 年至 2015 年间居住在斯德哥尔摩且无前列腺癌既往诊断的男性的队列研究设计。男性与瑞典国家健康和人口登记处相关联。我们报告了 2003 年或在其 PSA 检测指数时年龄在 50-79 岁的男性的随访情况。
使用多状态马尔可夫模型计算状态概率及其 95%置信区间（CI）。
在初始 PSA 值≥10ng/ml 且未被诊断患有前列腺癌的男性中，1 年内未进行进一步检测或仅检测到 PSA 值>3ng/ml 的比例分别为 21.7%（95%CI：19.5，23.9）、25.2%（95%CI：23.9，26.6）和 47.7%（95%CI：46.2，49.1），年龄分别为 50-59、60-69 和 70-79 岁。按合并症分层时，未发现显著变化。局限性包括缺乏患者病历的详细信息。这些详细信息将有助于更准确地评估适当的临床随访。
无论病史如何，在 PSA 检测指数后 1 年内，大量 PSA≥10ng/ml 的男性未得到适当随访。这可能部分解释了为什么机会性检测不如试验中的筛查那样有效，无法降低前列腺癌死亡率。
对于年龄在 50-69 岁、进行了前列腺特异性抗原（PSA）检测的男性，如果 PSA 水平>10ng/ml，则应进一步检查。然而，我们发现，在初始检测后 1 年内，每 10 名男性中就有 1 名未接受重复检测。这可能部分解释了为什么机会性前列腺癌检测不如筛查试验有效。
