Abstract：
UNASSIGNED: To quantify the ability of various PSA values in predicting the likelihood of developing metastatic or fatal prostate cancer in older men.
UNASSIGNED: We used a random sample of patients in the United States Veterans Health Administration to identify 80,706 men who had received PSA testing between ages 70 to 75. Our primary endpoint was time to development of either metastatic prostate cancer or death from prostate cancer. We used cumulative/dynamic modeling to account for competing events (death from non-prostate cancer causes) in studying both the discriminative ability of PSA as well as for positive predictive value and negative predictive value at three time points.
UNASSIGNED: PSA demonstrated time-dependent predictive discrimination, with receiver operating characteristic area under the curve at 5, 10, and 14 years decreasing from 0.83 to 0.77 to 0.73, respectively, but without statistically significant difference when stratified by race. At PSA thresholds between 1 and 8 ng/mL, the positive predictive value of developing advanced prostate cancer was significantly greater in Black than White patients. For instance, at a PSA > 3, at 5, 10, and 14 years, White patients had 2.4%, 2.9%, and 3.7% risk of an event, whereas Black patients had 4.3%, 6.5%, and 8.3% risk.
UNASSIGNED: In men aged 70 to 75 deciding whether to cease PSA testing with borderline-elevated PSA values, the risk of developing metastatic or fatal prostate cancer is quantifiable and relatively low. Risk assessment in this setting must account for the higher incidence of prostate cancer in Black men.
UNASSIGNED: We used a random sample of patients in the United States Veterans Health Administration to identify 80,706 men who had received PSA testing between ages 70 to 75. Our primary endpoint was time to development of either metastatic prostate cancer or death from prostate cancer. We used cumulative/dynamic modeling to account for competing events (death from non-prostate cancer causes) in studying both the discriminative ability of PSA as well as for positive predictive value and negative predictive value at three time points.
UNASSIGNED: PSA demonstrated time-dependent predictive discrimination, with receiver operating characteristic area under the curve at 5, 10, and 14 years decreasing from 0.83 to 0.77 to 0.73, respectively, but without statistically significant difference when stratified by race. At PSA thresholds between 1 and 8 ng/mL, the positive predictive value of developing advanced prostate cancer was significantly greater in Black than White patients. For instance, at a PSA > 3, at 5, 10, and 14 years, White patients had 2.4%, 2.9%, and 3.7% risk of an event, whereas Black patients had 4.3%, 6.5%, and 8.3% risk.
UNASSIGNED: In men aged 70 to 75 deciding whether to cease PSA testing with borderline-elevated PSA values, the risk of developing metastatic or fatal prostate cancer is quantifiable and relatively low. Risk assessment in this setting must account for the higher incidence of prostate cancer in Black men.
摘要：
■量化各种PSA值预测老年男性发生转移性或致命性前列腺癌的可能性的能力。
■我们使用美国退伍军人健康管理局的患者随机样本，确定了80,706名70至75岁接受PSA检测的男性。我们的主要终点是发生转移性前列腺癌或前列腺癌死亡的时间。我们使用累积/动态模型来解释竞争性事件（非前列腺癌原因导致的死亡），以研究PSA的辨别能力以及三个时间点的阳性预测值和阴性预测值。
■PSA表现出与时间相关的预测性辨别，在5年、10年和14年的曲线下接收器工作特征面积分别从0.83减少到0.77到0.73，但按种族分层时没有统计学上的显著差异。在1和8ng/mL之间的PSA阈值，Black患者发生晚期前列腺癌的阳性预测值显著高于White患者.例如,在PSA>3、5、10和14岁时，白人患者占2.4%，2.9%,发生事件的风险为3.7%，而黑人患者有4.3%，6.5%,8.3%的风险。
■在70至75岁的男性中，决定是否停止PSA测试，PSA值接近升高，发生转移性或致命性前列腺癌的风险是可量化的,且相对较低.这种情况下的风险评估必须考虑黑人男性前列腺癌的较高发病率。
■我们使用美国退伍军人健康管理局的患者随机样本，确定了80,706名70至75岁接受PSA检测的男性。我们的主要终点是发生转移性前列腺癌或前列腺癌死亡的时间。我们使用累积/动态模型来解释竞争性事件（非前列腺癌原因导致的死亡），以研究PSA的辨别能力以及三个时间点的阳性预测值和阴性预测值。
■PSA表现出与时间相关的预测性辨别，在5年、10年和14年的曲线下接收器工作特征面积分别从0.83减少到0.77到0.73，但按种族分层时没有统计学上的显著差异。在1和8ng/mL之间的PSA阈值，Black患者发生晚期前列腺癌的阳性预测值显著高于White患者.例如,在PSA>3、5、10和14岁时，白人患者占2.4%，2.9%,发生事件的风险为3.7%，而黑人患者有4.3%，6.5%,8.3%的风险。
■在70至75岁的男性中，决定是否停止PSA测试，PSA值接近升高，发生转移性或致命性前列腺癌的风险是可量化的,且相对较低.这种情况下的风险评估必须考虑黑人男性前列腺癌的较高发病率。
