Michael Zoe D, Kotamarti Srinath, Arcot Rohith, Morris Kostantinos, Shah Anand, Anderson John, Armstrong Andrew J, Gupta Rajan T, Patierno Steven, Barrett Nadine J, George Daniel J, Preminger Glenn M, Moul Judd W, Oeffinger Kevin C, Shah Kevin, Polascik Thomas J
The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
World J Mens Health. 2023 Jul;41(3):631-639. doi: 10.5534/wjmh.220068. Epub 2022 Aug 16.
Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network.
We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017-2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL.
The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 1.98, p=0.001).
Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.
前列腺癌（PCa）筛查可能导致惰性癌症的潜在过度诊断/过度治疗。有必要优化诊疗方法，以便更好地对患者进行风险分层。我们在一个全系统网络内启动一项新型筛查计划后，研究了基线前列腺特异性抗原（PSA）升高的中年男性的初始纵向结果。
我们评估了年龄在40至49岁之间、于2017年2月2日至2018年2月21日实施电子健康记录筛查算法后测量了PSA的基层医疗网络患者。该多学科算法的制定考虑了年龄、种族、家族史和PSA等因素，以提供一种个性化的泌尿外科转诊方法，用于共同决策。对PSA≥1.5 ng/mL的男性患者的结果进行了至2021年7月的评估。统计分析确定了与PCa检测相关的因素。临床显著性PCa（csPCa）定义为Gleason分级组（GGG）≥2或GGG1且PSA≥10 ng/mL。
研究队列包含564例患者，其中330例（58.5%）因PSA升高被转诊至泌尿外科。49例（8.7%）接受了活检；其中，20例（40.8%）活检结果为PCa。11例（占总队列的2.0%，占PCa诊断的55%）患有csPCa。多变量分析显示，早期转诊时机（比值比[OR]，4.58）和较高的PSA（OR，1.07）与活检时的PCa显著相关（p均<0.05），而其他风险因素则无此关联。转诊患者的平均PSA较高（2.97±1.98，p = 0.001）。
实施多学科筛查算法后的初步结果显示，在一小部分但很重要的40多岁男性中发现了PCa。这些结果为基线PSA测量提供了见解，以便对预期寿命较长的患者进行早期风险分层和检测csPCa。需要进一步随访，以确定这种中年筛查的预后意义，并优化基层医疗医生与泌尿外科医生的协作。
