Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Division of Surgery, Section of Urology, Augusta University, Augusta, GA.
Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Urol Oncol. 2019 May;37(5):298.e19-298.e27. doi: 10.1016/j.urolonc.2019.01.030. Epub 2019 Feb 13.
To determine in Ontario-based men with a single negative transrectal ultrasound-guided prostate biopsy the long-term rates of prostate cancer-specific mortality, diagnosis, and treatment; number of repeat biopsies; and predictors of prostate cancer diagnosis and mortality.
This was a population-based cohort study, using data from linked, validated health administrative databases, of all Ontario-based men with a negative first biopsy between January 1994 and October 2014. Patients were followed from time of first biopsy till death, administrative censoring, or end of study period. Cumulative incidence functions were used to calculate the study outcomes' cumulative incidences. Univariable and multivariable regression analyses using Fine and Gray's semiparametric proportional hazards model were used to assess predictors of prostate cancer diagnosis and mortality.
The study cohort included 95,675 men with a median age of 63.0years. Median follow-up was 8.1years. The 20-year cumulative rates of prostate cancer-specific mortality and diagnosis were 1.8% and 23.7%, respectively. Men ages 70 to 79 and 80 to 84 at initial biopsy had 20-year prostate cancer-specific mortality cumulative rates of 3.2% and 6.4% respectively. The 20-year cumulative rate of receiving radical prostatectomy was 7.6%. Higher socioeconomic status and urban residence were associated with higher diagnosis risks yet lower prostate cancer-specific mortality risks.
This is the first population-based study assessing long-term cancer outcomes in North American men with a single negative transrectal ultrasound-guided prostate biopsy. Following a negative initial biopsy, 23.7% of men are still diagnosed with and 1.8% die of prostate cancer within 20years. Cancer-specific mortality outcomes are significantly worse in older men, with prostate cancer mortality rates several times higher than the rest of the population.
在安大略省接受过单次经直肠超声引导前列腺活检的男性中，确定前列腺癌特异性死亡率、诊断和治疗的长期比率；重复活检的数量；以及前列腺癌诊断和死亡率的预测因素。
这是一项基于人群的队列研究，使用了 1994 年 1 月至 2014 年 10 月期间所有在安大略省接受过首次阴性活检的男性的相关、经验证的健康管理数据库中的数据。患者从首次活检时开始随访，直至死亡、行政随访或研究结束。使用累积发生率函数计算研究结果的累积发生率。使用 Fine 和 Gray 的半参数比例风险模型的单变量和多变量回归分析，用于评估前列腺癌诊断和死亡率的预测因素。
研究队列包括 95675 名中位年龄为 63.0 岁的男性。中位随访时间为 8.1 年。20 年的前列腺癌特异性死亡率和诊断累积率分别为 1.8%和 23.7%。在初次活检时年龄为 70 至 79 岁和 80 至 84 岁的男性，20 年的前列腺癌特异性死亡率累积率分别为 3.2%和 6.4%。20 年接受根治性前列腺切除术的累积率为 7.6%。较高的社会经济地位和城市居住与更高的诊断风险相关，但与更低的前列腺癌特异性死亡率风险相关。
这是第一项评估北美男性单次经直肠超声引导前列腺活检后长期癌症结局的基于人群的研究。在首次阴性活检后，20 年内仍有 23.7%的男性被诊断出患有前列腺癌，1.8%的男性死于前列腺癌。年龄较大的男性的癌症特异性死亡率结果明显更差，前列腺癌死亡率是其余人群的数倍。
