Borer J G, Sherman J, Solomon M C, Plawker M W, Macchia R J
Department of Urology, State University of New York Health Science Center, Brooklyn, USA.
J Urol. 1998 Feb;159(2):444-8. doi: 10.1016/s0022-5347(01)63945-4.
We determined whether 60 to 79-year-old men with a negative digital rectal examination and a serum prostate specific antigen (PSA) within age specific PSA reference ranges could safely forgo prostate biopsy.
We reviewed the medical records of all 60 to 79-year-old men at the Brooklyn Veterans Administration Medical Center who had a PSA assay, digital rectal examination and subsequent prostate biopsy for an abnormal rectal examination and/or PSA greater than 4.0 ng./ml. from January 1991 through August 1995. We compared our results using the standard reference range of 0 to 4.0 ng./ml. with those obtained had we used any of 4 different age specific PSA reference ranges.
We performed 1,280 prostate biopsies in 1,046 men with available PSA and digital rectal examination data. Using age specific PSA reference ranges 73 of 1,280 biopsies (5.7%) would have been avoided. Of those 73 avoided biopsies 15 (20.5%) had cancer that would have gone undetected and 9 of 15 (60%) undetected cancers had unfavorable histology. Results were not statistically significantly different among the 4 age specific PSA reference ranges. Regarding race, cancer detection rates were significantly higher for black compared with white men but there was no statistically significant difference for missed cancers or missed cancers with unfavorable histology.
In contrast to previous reports of unfavorable histological characteristics in only 5% of missed cancers using age specific PSA reference ranges, 60% of missed cancers in our patients exhibited unfavorable histology. We conclude that age specific PSA reference ranges did not safely eliminate the need for prostate biopsy in our study population. In 60 to 79-year-old men with a negative digital rectal examination we continue to use PSA greater than 4.0 ng./ml. as an indication for prostate biopsy.
我们确定了直肠指检阴性且血清前列腺特异性抗原（PSA）在年龄特异性PSA参考范围内的60至79岁男性是否可以安全地免去前列腺活检。
我们回顾了1991年1月至1995年8月在布鲁克林退伍军人管理局医疗中心接受PSA检测、直肠指检以及随后因直肠检查异常和/或PSA大于4.0 ng/ml而进行前列腺活检的所有60至79岁男性的病历。我们将使用0至4.0 ng/ml的标准参考范围得到的结果与使用4种不同年龄特异性PSA参考范围中的任何一种所获得的结果进行了比较。
我们对1046名有可用PSA和直肠指检数据的男性进行了1280次前列腺活检。使用年龄特异性PSA参考范围，1280次活检中有73次（5.7%）可以避免。在这73次避免的活检中，有15次（20.5%）患有未被发现的癌症，而15次未被发现的癌症中有9次（60%）组织学特征不佳。4种年龄特异性PSA参考范围之间的结果在统计学上无显著差异。关于种族，黑人的癌症检出率明显高于白人男性，但在漏诊癌症或组织学特征不佳的漏诊癌症方面没有统计学上的显著差异。
与之前报道的使用年龄特异性PSA参考范围时仅5%的漏诊癌症具有不良组织学特征不同，我们患者中60%的漏诊癌症表现出不良组织学特征。我们得出结论，在我们的研究人群中，年龄特异性PSA参考范围并不能安全地消除前列腺活检的必要性。对于直肠指检阴性的60至79岁男性，我们继续将PSA大于4.0 ng/ml作为前列腺活检的指征。
