Maeda-Minami Ayako, Nishikawa Tomoki, Ishikawa Hideki, Mutoh Michihiro, Akimoto Kazunori, Matsuyama Yutaka, Mano Yasunari, Uemura Hiroji
Faculty of Pharmaceutical Sciences, Tokyo University of Science, Yamazaki, Noda, 2641, 278-8510, Chiba, Japan.
Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Genes Environ. 2023 Oct 17;45(1):25. doi: 10.1186/s41021-023-00280-7.
Prostate cancer is one of the most common cancers among men worldwide and the fourth most common cause of death. The number of prostate cancer cases and deaths is increasing every year because of population aging. This study aimed to clarify the risk of developing prostate cancer due to fluctuations in Prostate Specific Antigen (PSA) levels in patients without a history of prostate cancer using large medical information data.
This retrospective cohort included 1707 male patients aged 60 years or older who had a PSA level measurement date (2-PSA) within 3 months or more and 2 years from the first PSA level measurement date (1-PSA) in the database between 2008 and 2019. We subtracted 1-PSA from 2-PSA and designated patients with a higher 2-PSA than 1-PSA to the "up" group (n = 967) and patients with a lower 2-PSA than 1-PSA to the "down" group (n = 740). By using Cox proportional hazards model, a significant increase in prostate cancer risk was observed in the up group compared with the down group (adjusted hazard ratio [HR] = 1.82, 95% confidence interval [CI] = 1.21-2.72; adjusted for patient background factors). Subgroup analysis showed that patients with PSA levels < 4 ng/mL had a significantly increased risk of developing prostate cancer if the next PSA level increases by approximately 20% (adjusted HR = 2.94, 95% CI = 1.14-7.58), and patients with PSA levels of 4 ng/mL or higher if the next PSA level is decreased by approximately 20% had a significantly reduced risk of developing prostate cancer (adjusted HR = 0.36, 95% CI = 0.18-0.74), compared to that with no change.
This is the first study to clarify the association between PSA variability and risk of developing prostate cancer in patients without a history of prostate cancer. These results suggest that the suppression of elevated PSA levels may lead to the prevention of prostate cancer and that it would be better to perform a biopsy because the risk of developing prostate cancer may increase in the future if the PSA value increases above a certain level.
前列腺癌是全球男性中最常见的癌症之一，也是第四大常见死因。由于人口老龄化，前列腺癌病例数和死亡人数每年都在增加。本研究旨在利用大型医疗信息数据，阐明无前列腺癌病史患者中前列腺特异性抗原（PSA）水平波动导致前列腺癌发生的风险。
这项回顾性队列研究纳入了1707名60岁及以上的男性患者，他们在2008年至2019年期间在数据库中有距首次PSA水平测量日期（1-PSA）3个月或更长时间且在2年内的PSA水平测量日期（2-PSA）。我们用2-PSA减去1-PSA，将2-PSA高于1-PSA的患者归为“上升”组（n = 967），将2-PSA低于1-PSA的患者归为“下降”组（n = 740）。通过使用Cox比例风险模型，与“下降”组相比，“上升”组中观察到前列腺癌风险显著增加（调整后风险比[HR]=1.82，95%置信区间[CI]=1.21-2.72；根据患者背景因素进行调整）。亚组分析显示，PSA水平<4 ng/mL的患者，如果下一次PSA水平增加约20%，患前列腺癌的风险显著增加（调整后HR = 2.94，95% CI = 1.14-7.58），而PSA水平为4 ng/mL或更高的患者，如果下一次PSA水平降低约20%，与无变化相比，患前列腺癌的风险显著降低（调整后HR = 0.36，95% CI = 0.18-0.74）。
这是第一项阐明无前列腺癌病史患者中PSA变异性与前列腺癌发生风险之间关联的研究。这些结果表明，抑制升高的PSA水平可能有助于预防前列腺癌，并且如果PSA值升高到一定水平以上，未来患前列腺癌的风险可能增加，因此最好进行活检。
