背景:用于早期检测前列腺癌(PCa)的前列腺特异性抗原(PSA)的一个缺点是必须对许多男性进行筛查,活检,并被诊断为防止一人死亡。
目的:提高早期筛查致死性PCa的特异性。
方法:我们在基于人群的队列中进行了病例对照研究。在Västerbotten的基于人群的队列中,在冷冻保存的血液中测量了PSA和三种其他激肽释放酶,瑞典。从1986年到2009年,在40岁、50岁和60岁提供血液的40379名男性中,有12542名男性被随访超过15年。从这个队列中,瑞典癌症登记处确定了1423例PCa事件,235伴远处转移。
方法:不同PSA水平的远处转移风险和基于四种激肽释放酶标志物的预设统计模型。
结论:大多数转移病例发生在50岁(69%)或60岁(74%)的前四分位数PSA的男性中。而PSA低于中位数的男性20年转移风险较低(≤0.6%).在PSA>2ng/ml的男性中,与单纯PSA相比,基于4种激肽释放酶标志物的预设模型显著增强了对转移的预测.该模型将PSA>2ng/ml的所有男性中约有一半定义为低风险,并且具有≤1%的15年转移风险。
结论:50-60岁的筛查应集中于PSA位于前四分位数的男性。标记面板可以帮助活检决策。
结果:对于五十多岁的男性,筛查应集中在PSA值最高的10%至25%的人群中,因为大多数随后的远处转移病例都是在这些男性中发现的。在PSA升高的男性中测试四种激肽释放酶标志物可以帮助活检决策。
BACKGROUND: A disadvantage of prostate-specific antigen (PSA) for the early detection of prostate cancer (PCa) is that many men must be screened, biopsied, and diagnosed to prevent one death.
OBJECTIVE: To increase the specificity of screening for lethal PCa at an early stage.
METHODS: We conducted a
case-control study nested within a population-based cohort. PSA and three additional kallikreins were measured in cryopreserved blood from a population-based cohort in Västerbotten, Sweden. Of 40379 men providing blood at ages 40, 50, and 60 yr from 1986 to 2009, 12542 men were followed for >15 yr. From this cohort, the Swedish Cancer Registry identified 1423 incident PCa cases, 235 with distant metastasis.
METHODS: Risk of distant metastasis for different PSA levels and a prespecified statistical model based on the four kallikrein markers.
CONCLUSIONS: Most metastatic cases occurred in men with PSA in the top quartile at age 50 yr (69%) or 60 yr (74%), whereas 20-yr risk of metastasis for men with PSA below median was low (≤0.6%). Among men with PSA >2 ng/ml, a prespecified model based on four kallikrein markers significantly enhanced the prediction of metastasis compared with PSA alone. About half of all men with PSA >2 ng/ml were defined as low risk by this model and had a ≤1% 15-yr risk of metastasis.
CONCLUSIONS: Screening at ages 50-60 yr should focus on men with PSA in the top quartile. A marker panel can aid biopsy decision making.
RESULTS: For men in their fifties, screening should focus on those in the top 10% to 25% of PSA values because the majority of subsequent cases of distant metastasis are found among these men. Testing of four kallikrein markers in men with an elevated PSA could aid biopsy decision making.