PLCO 筛查试验中游离前列腺特异性抗原和临床显著及致命性前列腺癌。
Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial.
机构信息
Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
J Urol. 2023 Oct;210(4):630-638. doi: 10.1097/JU.0000000000003603. Epub 2023 Jun 29.
PURPOSE
We studied whether adding percent free PSA to total PSA improves prediction of clinically significant prostate cancer and fatal prostate cancer.
MATERIALS AND METHODS
A total of 6,727 men within the intervention arm of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) had baseline percent free PSA. Of this cohort, 475 had clinically significant prostate cancer and 98 had fatal prostate cancer. Cumulative incidence and Cox analyses were conducted to evaluate the association between percent free PSA/PSA and clinically significant prostate cancer/fatal prostate cancer. Harrell's C index evaluated predictive ability. Kaplan-Meier analysis assessed survival.
RESULTS
Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median percent free PSA was 18%. Cumulative incidence of fatal prostate cancer for men with baseline PSA ≥2 ng/mL and percent free PSA ≤10 was 3.2% and 6.1% at 15 and 25 years, respectively, compared to 0.03% and 1.1% for men with percent free PSA >25%. In younger men (55-64 years) with baseline PSA 2-10 ng/mL, C index improved from 0.56 to 0.60 for clinically significant prostate cancer and from 0.53 to 0.64 for fatal prostate cancer with addition of percent free PSA. In older men (65-74 years), C index improved for clinically significant prostate cancer from 0.60 to 0.66, with no improvement in fatal prostate cancer. Adjusting for age, digital rectal exam, family history of prostate cancer, and total PSA, percent free PSA was associated with clinically significant prostate cancer (HR 1.05, < .001) per 1% decrease. Percent free PSA improved prediction of clinically significant prostate cancer and fatal prostate cancer for all race groups.
CONCLUSIONS
In a large U.S. screening trial, the addition of percent free PSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of clinically significant prostate cancer and fatal prostate cancer. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.
目的
我们研究了在总 PSA 中加入游离 PSA 百分比是否能提高对临床显著前列腺癌和致命性前列腺癌的预测能力。
材料与方法
PLCO（前列腺、肺、结直肠和卵巢癌筛查试验）干预组的 6727 名男性在基线时均有游离 PSA 百分比。在这一队列中，有 475 人患有临床显著前列腺癌，98 人患有致命性前列腺癌。进行累积发病率和 Cox 分析，以评估游离 PSA/PSA 与临床显著前列腺癌/致命性前列腺癌之间的关系。哈雷尔 C 指数评估预测能力。Kaplan-Meier 分析评估生存情况。
结果
中位随访时间为 19.7 年，中位基线 PSA 为 1.19ng/ml，中位游离 PSA 百分比为 18%。基线 PSA≥2ng/ml 且游离 PSA 百分比≤10%的男性，15 年和 25 年时致命性前列腺癌的累积发病率分别为 3.2%和 6.1%，而游离 PSA 百分比>25%的男性则分别为 0.03%和 1.1%。在基线 PSA 为 2-10ng/ml 的年轻男性（55-64 岁）中，加入游离 PSA 后，临床显著前列腺癌的 C 指数从 0.56 提高到 0.60，致命性前列腺癌的 C 指数从 0.53 提高到 0.64。在年龄较大的男性（65-74 岁）中，临床显著前列腺癌的 C 指数从 0.60 提高到 0.66，而致命性前列腺癌则没有改善。在调整年龄、直肠指检、前列腺癌家族史和总 PSA 后，每降低 1%的游离 PSA 与临床显著前列腺癌相关（HR 1.05，<0.001）。游离 PSA改善了所有种族组临床显著前列腺癌和致命性前列腺癌的预测。
结论
在一项大型美国筛查试验中，在基线 PSA≥2ng/ml 的男性中，在总 PSA 中加入游离 PSA 百分比提高了对临床显著前列腺癌和致命性前列腺癌的预测能力。游离 PSA 应该用于风险分层筛查，减少不必要的前列腺活检。
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