Fogg Ryan W, Krzastek Sarah C, Vissichelli Nicole, Defor Edem, Sabo Roy, Ghatas Mina, Sima Adam, Swavely Natalie, Grob Baruch M, Carter William, Goetz Lance, Klausner Adam P
Department of Urology, Virginia Commonwealth University Health System, Richmond, Virginia.
Central Virginia Medical System, Richmond, Virginia.
J Urol. 2025 Oct;214(4):374-382. doi: 10.1097/JU.0000000000004644. Epub 2025 Jun 17.
Men with spinal cord injury (SCI) experience frequent urinary tract inflammation and manipulation as well as chronic hypogonadism, all of which may artifactually alter PSA values. Thus, established PSA reference ranges and age-adjusted values may not be accurate in this population. This study's objective was to use national Department of Veterans Affairs data to establish threshold values for PSA in the SCI population to guide decision-making in prostate cancer screening.
All PSA values in the national Department of Veterans Affairs system in men with SCI were collected between 1999 and 2019. Values collected before a diagnosis of SCI and after a diagnosis of prostate cancer were excluded. Determination of SCI was based on a list of International Classification of Diseases, 9th Revision and 10th Revision codes. Mixed-effect quantile regression was used to estimate percentile PSA values adjusted by age and time since SCI. These values were then compared with published values in the non-SCI population.
A total of 34,899 male veterans with SCI were included in the analysis with a total of 240,131 PSA values. Using the best-fit model, age-adjusted PSA values for the 25th, 50th, 75th, and 95th percentiles were created. The 95th age-adjusted percentile values for PSA in the SCI population were 40 to 49 years: 2.5 ng/mL; 50 to 59 years: 2.6 ng/mL; 60 to 69 years: 2.6 ng/mL; and 70 to 79 years: 2.8 ng/mL.
Using a large, geographically diverse database, age-adjusted PSA values in the SCI population can be generated. While PSA values of the SCI population are comparable in younger men, as the SCI population ages, PSA fails to rise and stagnates at around 3 ng/mL.
脊髓损伤（SCI）男性患者经常经历泌尿系统炎症和操作以及慢性性腺功能减退，所有这些都可能人为地改变前列腺特异性抗原（PSA）值。因此，既定的PSA参考范围和年龄校正值在该人群中可能不准确。本研究的目的是利用美国退伍军人事务部的全国数据来确定SCI人群中PSA的阈值，以指导前列腺癌筛查的决策。
收集1999年至2019年期间美国退伍军人事务部系统中SCI男性患者的所有PSA值。排除SCI诊断之前和前列腺癌诊断之后收集的值。SCI的确定基于国际疾病分类第9版和第10版代码列表。采用混合效应分位数回归来估计按年龄和SCI后时间调整的PSA百分位数。然后将这些值与非SCI人群中公布的值进行比较。
共有34899名患有SCI的男性退伍军人纳入分析，共有240131个PSA值。使用最佳拟合模型，创建了第25、50、75和95百分位数的年龄校正PSA值。SCI人群中PSA的第95年龄校正百分位数在40至49岁为：2.5 ng/mL；50至59岁为：2.6 ng/mL；60至69岁为：2.6 ng/mL；70至79岁为：2.8 ng/mL。
利用一个大型、地域多样的数据库，可以生成SCI人群中年龄校正后的PSA值。虽然SCI人群中年轻男性的PSA值相当，但随着SCI人群年龄增长，PSA未能上升并停滞在约3 ng/mL左右。
