Outcomes and trends of prostate biopsy for prostate cancer in Chinese men from 2003 to 2011.
Outcomes and trends of prostate biopsy for prostate cancer in Chinese men from 2003 to 2011.
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DOI：
10.1371/journal.pone.0049914
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Ding Q
中科院分区：
文献类型：
--
作者：
Na R;Jiang H;Kim ST;Wu Y;Tong S;Zhang L;Xu J;Sun Y;Ding Q
前列腺特异性抗原（PSA）筛查在中国越来越受欢迎，但其对活检特征和结果的影响知之甚少。我们的目的是描述自PSA检测使用增加以来，中国男性10年内前列腺活检的结果和趋势。对2003-2011年在中国上海华山医院接受前列腺活检治疗PCa的所有男性（n =1，650）进行了评价。 收集每例患者的人口统计学和临床信息，包括年龄、直肠指检（DRE）、经直肠超声（前列腺体积和结节）、总前列腺特异性抗原（tPSA）水平和活检前游离PSA比值（fPSA/tPSA）。2007年10月之前使用6个穿刺针或2007年10月之后使用10个穿刺针进行前列腺活检。Logistic回归和多因素分析用于评估我们的数据。前列腺活检对PCa的总体阳性率为47%，该比率从2003年的74%显著下降至2011年的33%（P趋势= 0.004）。 诊断时的年龄略有增加（P趋势= 0.04），而fPSA/tPSA显著降低（P趋势= 1.11×10-5）。 未观察到tPSA水平、前列腺体积或阳性结节比例的统计学显著趋势。该模型包括多个人口统计和临床变量（即，年龄、DRE、tPSA、fPSA/tPSA和经直肠超声结果）（AUC = 0.93）在预测PCa风险方面的统计学表现优于仅包括PSA（AUC = 0.85）或fPSA/tPSA（AUC = 0.66）的模型（P<0.05）。 在tPSA水平低于20 ng/mL的男性亚组中观察到类似的结果（AUC = 0.87，vs. tPSA的AUC = 0.62，P<0.05）。 在过去的10年里，在该机构接受前列腺活检的男性中PCa和高级别PCa的检出率显著下降，可能是由于PSA检测的使用增加。PCa的人口统计学和临床变量的预测性能非常好。这些变量应用于临床，以确定是否需要前列腺活检。
Prostate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood. Our objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the increasing use of PSA tests. All men (n = 1,650) who underwent prostate biopsy for PCa at Huashan Hospital, Shanghai, China from 2003–2011 were evaluated. Demographic and clinical information was collected for each patient, including age, digital rectal examination (DRE), transrectal ultrasound (prostate volume and nodule), total prostate-specific antigen (tPSA) levels and free PSA ratio (fPSA/tPSA) prior to biopsy. Prostate biopsy was performed using six cores before October 2007 or ten cores thereafter. Logistic regression and multivariate analysis were used to evaluate our data. The overall positive rate of prostate biopsy for PCa was 47% and the rate decreased significantly over the years from 74% in 2003 to 33% in 2011 (P-trend = 0.004) . Age at diagnosis was slightly increased (P-trend = 0.04) while fPSA/tPSA was significantly decreased (P-trend = 1.11×10-5). A statistically significant trend was not observed for tPSA levels, prostate volume, or proportion of positive nodule. The model including multiple demographic and clinical variables (i.e., age, DRE, tPSA, fPSA/tPSA and transrectal ultrasound results) (AUC = 0.93) statistically outperformed models that included only PSA (AUC = 0.85) or fPSA/tPSA (AUC = 0.66) to predict PCa risks (P<0.05). Similar results were observed in a subgroup of men whose tPSA levels were lower than 20 ng/mL (AUC = 0.87, vs. AUC of tPSA = 0.62, P<0.05). Detection rates of PCa and high-grade PCa among men that underwent prostate biopsy at the institution has decreased significantly in the past 10 years, likely due to increasing use of PSA tests. Predictive performance of demographic and clinical variables of PCa was excellent. These variables should be used in clinics to determine the need for prostate biopsy.
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