Abstract：
OBJECTIVE: Studies evaluating the role of baseline midlife prostate-specific antigen (PSA) as a predictor of development and progression of prostate cancer relied predominately on cohorts from the pre-PSA screening introduction era. The aim of our study was to examine the role of baseline PSA prior to the age of 60 yr as a predictor of developing lethal prostate cancer using a contemporary North American cohort.
METHODS: Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer.
UNASSIGNED: A total of 129067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSACONCLUSIONS: Baseline PSA is a very strong predictor of the subsequent risk of developing lethal prostate cancer in a large contemporary diverse North American cohort, which was exposed to opportunistic PSA screening. The association was far larger than that found for polygenic risk scores, confirming that baseline PSA prior to the age of 60 yr is the most effective tool for adjusting subsequent screening. Compared with studies of unscreened cohorts, there was a smaller difference in discrimination between incident and lethal disease, reflecting the influence of screening.
RESULTS: In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing.
METHODS: Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer.
UNASSIGNED: A total of 129067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSA
RESULTS: In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing.
摘要：
目的：评估基线中年前列腺特异性抗原（PSA）作为前列腺癌发生和进展的预测因子的研究主要依赖于PSA筛查前的队列。我们研究的目的是使用当代北美队列研究60岁之前的基线PSA作为发生致命前列腺癌的预测因子的作用。
方法：我们的队列包括1995年至2019年通过我们的卫生系统首次接受PSA的所有40-59岁男性。根据年龄将患者分为四类：40-44、45-49、50-54和55-59岁。基线PSA是感兴趣的预测因子。致死性疾病被定义为在诊断或随访期间死于前列腺癌或发展为转移性疾病。癌症特异性死亡率和总死亡率是通过将我们的数据库链接到密歇根生命记录注册表来获得的。竞争风险回归用于评估PSA和致死性前列腺癌之间的关联。
■在研究期间，共有129067名男性符合纳入标准。无癌患者的中位随访时间为7.4年。对于40-44岁、45-49岁、50-54岁和55-59岁的男性，20年的致死性前列腺癌的估计发生率为0.02%，0.14%，0.33%，PSA<中位数的男性为0.51％，和0.79%，0.16%，2.5%,PSA≥90百分位数的男性为5.4%，分别。对于相同的年龄类别，20年时任何前列腺癌的估计发病率为，分别,1.6%,2.9%,3.9%,PSA<中位数的男性为5.8％，25%,28%,38%,PSA≥90百分位数的男性为39%。在多变量分析中，PSA≥90百分位数的男性致死性疾病的风险比为7.48（95％置信区间[CI]：6.20-9.03），与PSA<中位数相比。在多变量分析中，PSA≥90百分位数的男性前列腺癌发病率的风险比为20.47倍(95%CI:18.58-22.55),与PSA<中位数的患者相比。局限性包括中位随访时间比以前的文献短。
结论：在一个庞大的当代不同的北美队列中，基线PSA是随后发生致死性前列腺癌的风险的非常强的预测因子。暴露于机会性PSA筛查。这种关联远远大于多基因风险评分，确认60岁之前的基线PSA是调整后续筛查的最有效工具。与未筛查队列的研究相比，事故和致命疾病之间的区别较小，反映了筛选的影响。
结果：在这项研究中，我们发现，单个基线前列腺特异性抗原（PSA）值可以强烈预测随后发生转移性前列腺癌的风险，以及死于前列腺癌的风险。因此,初始PSA水平可用于调节后续PSA测试的频率。
方法：我们的队列包括1995年至2019年通过我们的卫生系统首次接受PSA的所有40-59岁男性。根据年龄将患者分为四类：40-44、45-49、50-54和55-59岁。基线PSA是感兴趣的预测因子。致死性疾病被定义为在诊断或随访期间死于前列腺癌或发展为转移性疾病。癌症特异性死亡率和总死亡率是通过将我们的数据库链接到密歇根生命记录注册表来获得的。竞争风险回归用于评估PSA和致死性前列腺癌之间的关联。
■在研究期间，共有129067名男性符合纳入标准。无癌患者的中位随访时间为7.4年。对于40-44岁、45-49岁、50-54岁和55-59岁的男性，20年的致死性前列腺癌的估计发生率为0.02%，0.14%，0.33%，PSA<中位数的男性为0.51％，和0.79%，0.16%，2.5%,PSA≥90百分位数的男性为5.4%，分别。对于相同的年龄类别，20年时任何前列腺癌的估计发病率为，分别,1.6%,2.9%,3.9%,PSA<中位数的男性为5.8％，25%,28%,38%,PSA≥90百分位数的男性为39%。在多变量分析中，PSA≥90百分位数的男性致死性疾病的风险比为7.48（95％置信区间[CI]：6.20-9.03），与PSA<中位数相比。在多变量分析中，PSA≥90百分位数的男性前列腺癌发病率的风险比为20.47倍(95%CI:18.58-22.55),与PSA<中位数的患者相比。局限性包括中位随访时间比以前的文献短。
结论：在一个庞大的当代不同的北美队列中，基线PSA是随后发生致死性前列腺癌的风险的非常强的预测因子。暴露于机会性PSA筛查。这种关联远远大于多基因风险评分，确认60岁之前的基线PSA是调整后续筛查的最有效工具。与未筛查队列的研究相比，事故和致命疾病之间的区别较小，反映了筛选的影响。
结果：在这项研究中，我们发现，单个基线前列腺特异性抗原（PSA）值可以强烈预测随后发生转移性前列腺癌的风险，以及死于前列腺癌的风险。因此,初始PSA水平可用于调节后续PSA测试的频率。
