在接受 PSA 筛查的人群中，前列腺癌的发病率和死亡率在阴性活检后。

Prostate Cancer Incidence and Mortality Following a Negative Biopsy in a Population Undergoing PSA Screening.

机构信息

HCA Healthcare / USF Morsani College of Medicine Graduate Medical Education Programs, Tampa, FL.

Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD.

出版信息

Urology. 2021 Sep;155:62-69. doi: 10.1016/j.urology.2021.05.060. Epub 2021 Jun 26.

DOI:10.1016/j.urology.2021.05.060

PMID:34186135

Abstract

OBJECTIVE

Transrectal ultrasound guided biopsy for diagnostic workup for prostate cancer (PCa) has a substantial false negative rate. We sought to estimate PCa incidence and mortality following negative biopsy in a cohort of men undergoing prostate cancer screening.

SUBJECTS AND METHODS

The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial randomized participants 55-74 years to an intervention vs control arm. Intervention arm men received annual prostate-specific antigen (PSA) tests for 6 years and digital rectal exams (DRE) for 4 years. We examined the cohort of men with a positive PSA (> 4 ng/mL) or DRE screen followed within one year by a negative biopsy. PCa incidence and mortality rates from time of first negative biopsy were analyzed as a function of PSA level at diagnosis and other factors. Cumulative incidence and mortality rates accounting for competing risk were estimated. Multivariate proportional hazards regression was utilized to estimate hazard ratios (HRs) of PCa outcomes by PSA level, controlling for age and race.

RESULTS

The negative biopsy cohort included 2855 men. Median (25th/75th) age at biopsy was 65 (61/69) years; biopsies occurred between 1994 and 2006. Median (25/75th) follow-up was 13.2 (6.5/16.8) years for incidence and 16.6 (12.3/19.2) years for mortality. 740 PCa cases were diagnosed, with 33 PCa deaths. Overall 20-year cumulative PCa incidence and mortality rates were 26.4% (95% CI: 24.8-28.1) and 1.2% (95% CI: 0.9-1.7), respectively. HRs for PCa incidence and mortality increased significantly with increasing PSA.

CONCLUSION

The mortality rate from PCa through 20 years following a negative biopsy is low.

摘要

目的

经直肠超声引导前列腺癌（PCa）诊断性活组织检查的假阴性率较高。我们旨在评估在接受前列腺癌筛查的男性队列中，经活检为阴性后的 PCa 发病率和死亡率。

受试者和方法

前列腺、肺、结直肠和卵巢（PLCO）癌症筛查试验将参与者随机分为干预组和对照组，年龄在 55-74 岁之间。干预组男性接受了为期 6 年的年度前列腺特异性抗原（PSA）检测和 4 年的数字直肠检查（DRE）。我们研究了一组 PSA（>4ng/mL）或 DRE 筛查阳性的男性队列，这些男性在一年内接受了阴性活检。分析了首次阴性活检时 PCa 发病率和死亡率，其影响因素包括诊断时 PSA 水平和其他因素。通过竞争风险计算累积发病率和死亡率。利用多变量比例风险回归估计按 PSA 水平划分的 PCa 结局的风险比（HR），同时控制年龄和种族因素。

结果

阴性活检队列包括 2855 名男性。活检时的中位（25/75th）年龄为 65（61/69）岁；活检发生在 1994 年至 2006 年之间。发病率的中位（25/75th）随访时间为 13.2（6.5/16.8）年，死亡率的中位（25/75th）随访时间为 16.6（12.3/19.2）年。诊断出 740 例 PCa 病例，其中 33 例死于 PCa。总的 20 年累积 PCa 发病率和死亡率分别为 26.4%（95%CI：24.8-28.1）和 1.2%（95%CI：0.9-1.7）。随着 PSA 的增加，PCa 发病率和死亡率的 HR 显著增加。