Reissigl A, Pointner J, Horninger W, Ennemoser O, Strasser H, Klocker H, Bartsch G
Department of Urology, University of Innsbruck, Austria.
Urology. 1995 Nov;46(5):662-5. doi: 10.1016/S0090-4295(99)80297-0.
This study was designed to compare the usefulness of the normal prostate-specific antigen (PSA) level and the age-referenced PSA level in a large screening study for early detection of prostate cancer.
A total of 21,078 subjects (aged 45 to 75 years) were participants in a 1-year prostate cancer screening project with PSA as the initial test. Of the volunteers, 1618 (8%) showed an elevated PSA level according to age-specific reference ranges, and using the normal PSA cutoff point (4.0 ng/mL), 1872 (9%) had elevated PSA levels between 4.0 and 6.5 ng/mL.
Biopsies in both groups were performed if the PSA level was elevated. We evaluated the effect on biopsy rate and cancer detection. A PSA cutoff point of 2.5 ng/mL in men 45 to 49 years old and a PSA cutoff point of 3.5 ng/mL in men 50 to 59 years old with normal digital rectal examination findings resulted in an 8% increase in the number of biopsies (66 of 778) and an 8% increase in organ-confined cancer detection. An increasing cutoff of 4.5 ng/mL in men 60 to 69 years old and 6.5 ng/mL in men 70 to 75 years old resulted in 21% fewer biopsies (205 of 983) and would have missed 4% of organ-confined tumors (8 of 220).
We conclude that the use of PSA age-specific reference ranges increases the detection of clinically important and organ-confined cancers in young men and decreases the number of biopsies in older men.
本研究旨在比较在一项大型前列腺癌早期检测筛查研究中，正常前列腺特异性抗原（PSA）水平和年龄校正后的PSA水平的效用。
共有21078名年龄在45至75岁之间的受试者参与了一项为期1年的前列腺癌筛查项目，该项目以PSA作为初始检测指标。在这些志愿者中，根据年龄特异性参考范围，有1618人（8%）的PSA水平升高；而使用正常PSA临界值（4.0 ng/mL）时，有1872人（9%）的PSA水平在4.0至6.5 ng/mL之间升高。
如果PSA水平升高，两组均进行活检。我们评估了对活检率和癌症检测的影响。对于45至49岁且直肠指检结果正常的男性，PSA临界值设为2.5 ng/mL，对于50至59岁的男性，PSA临界值设为3.5 ng/mL，这使得活检数量增加了8%（778人中的66人），器官局限性癌症检测增加了8%。对于60至69岁的男性，将临界值提高到4.5 ng/mL，对于70至75岁的男性，提高到6.5 ng/mL，导致活检数量减少了21%（983人中的205人），并且会漏诊4%的器官局限性肿瘤（220例中的8例）。
我们得出结论，使用年龄特异性PSA参考范围可增加年轻男性中具有临床意义的器官局限性癌症的检测，并减少老年男性的活检数量。
