中年时期前列腺特异性抗原水平与黑人男性侵袭性前列腺癌。
Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men.
机构信息
Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.
出版信息
Eur Urol. 2019 Mar;75(3):399-407. doi: 10.1016/j.eururo.2018.08.032. Epub 2018 Sep 17.
BACKGROUND
Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men.
OBJECTIVE
To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men.
DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40-64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA.
RESULTS AND LIMITATIONS
Median PSA among controls was 0.72, 0.80, 0.94, and 1.03ng/ml for age groups 40-49, 50-54, 55-59, and 60-64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2-539) for 40-54 yr and 71.7 (95% CI, 23.3-288) for 55-64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3-infinity) for 40-54 yr and 51.8 (95% CI, 11.0-519) for 55-64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation.
CONCLUSIONS
PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies.
PATIENT SUMMARY
Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.
背景
在中年时测量前列腺特异性抗原（PSA）可预测白人男性的长期前列腺癌（PCa）死亡率。
目的
确定中年时的基线 PSA 水平是否可预测黑人男性的侵袭性 PCa 风险。
设计、地点和参与者：这是一项在 2002 年至 2009 年间招募的南方社区队列研究中的黑人男性的巢式病例对照研究。这是美国东南部的一个前瞻性队列，通过社区卫生中心招募参与者。共有 197 名在研究入组时年龄为 40-64 岁的新发 PCa 患者和 569 名年龄、采血日期和入组地点匹配的对照者。在入组时采集并储存的血液中测量总 PSA。
结局测量和统计分析
总 PCa 和侵袭性 PCa（91 例侵袭性 PCa：Gleason≥7、美国癌症联合委员会分期 III/IV 或 PCa 特异性死亡）。基于基线 PSA 分类，使用精确条件逻辑回归估计 PCa 的比值比（OR）及其 95%置信区间（CI）。
结果和局限性
对照组中年龄在 40-49、50-54、55-59 和 60-64 岁的男性分别有 0.72、0.80、0.94 和 1.03ng/ml 的中位 PSA；90 百分位水平分别为 1.68、1.85、2.73 和 3.33ng/ml。此外，总病例和侵袭性病例中 95%和 97%的基线 PSA 高于年龄特异性中位数。中位随访时间为 9 年。与 PSA>90 百分位相比，PSA≤中位数的总 PCa 的 OR 在 40-54 岁时为 83.6（95%CI，21.2-539），在 55-64 岁时为 71.7（95%CI，23.3-288）。对于侵袭性癌症，40-54 岁时 OR 为 174（95%CI，32.3-无穷大），55-64 岁时 OR 为 51.8（95%CI，11.0-519）。使用了基于分期、分级和死亡率的侵袭性 PCa 复合终点，这是一个局限性。
结论
中年时的 PSA 水平强烈预测了黑人男性的总 PCa 和侵袭性 PCa。对照组中的 PSA 水平与先前研究中的白人对照组相似。
患者总结
中年时的前列腺特异性抗原（PSA）水平强烈预测黑人男性侵袭性前列腺癌的未来发展。基于中年 PSA 的靶向筛查可能会识别高风险男性，同时最大限度地减少低风险男性的筛查。
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