Individualized screening interval for prostate cancer based on prostate-specific antigen level - Results of a prospective, randomized, population-based study
Individualized screening interval for prostate cancer based on prostate-specific antigen level - Results of a prospective, randomized, population-based study
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DOI：
10.1001/archinte.165.16.1857
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发表时间：
2005-09-12
影响因子：
--
通讯作者：
Hugosson, J
中科院分区：
文献类型：
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作者：
Aus, G;Damber, JE;Hugosson, J
背景：本研究的目的是评估前列腺癌的未来累积风险与血液中前列腺特异性抗原（PSA）水平的关系，并确定该信息是否可用于个体化PSA检测间隔。方法：该研究纳入了9972名男性（年龄50-66岁）中的5855名，他们接受了一项前瞻性、随机的前列腺癌早期检测研究的邀请。我们使用的方案是基于1995年和1996年开始的两年一次的PSA测量。血清PSA水平为3.0 ng/mL或更高的男性接受前列腺活检。结果：在5855名男性中，在7.6年的中位随访（截至2003年7月1日）后，发现539例前列腺癌（9.2%）。随访期间癌症检出率与PSA水平的关系如下：0 ~ 0.49 ng/mL, 0% (0/958)；0.50 ~ 0.99 ng/ mL, 0.9% (17/1992)；1.00 ~ 1.49 ng/mL, 4.7% (54/ 1138)；1.50 ~ 1.99 ng/mL, 12.3% (70/571)；2.00 ~ 2.49 ng/mL, 21.4% (67/313)；2.50 ~ 2.99 ng/mL, 25.2% (56/222)；3.00 ~ 3.99 ng/mL, 33.3% (89/267)；4.00 ~ 6.99 ng/mL, 38.9% (103/265)；7.00 ~ 9.99 ng/mL, 50.0% (30/60)；对于初始PSA为10.00 ng/mL或更高的男性，76.8%（53/69）。在2950名（50.4%的筛查人群）初始PSA水平低于1 ng/mL的男性中，3年内未发现一例前列腺癌。结论：重新检测间隔应根据PSA水平进行个体化，PSA水平低于1 ng/mL的男性大群体可以安全地安排3年的检测间隔。
Background: The aim of the present study was to evaluate the future cumulative risk of prostate cancer in relation to levels of prostate-specific antigen (PSA) in blood and to determine whether this information could be used to individualize the PSA testing interval.Methods: The study included 5855 of 9972 men (aged 50-66 years) who accepted an invitation to participate in a prospective, randomized study of early detection for prostate cancer. We used a protocol based on biennial PSA measurements starting from 1995 and 1996. Men with serum PSA levels of 3.0 ng/mL or more were offered prostate biopsies.Results: Among the 5855 men, 539 cases of prostate cancer (9.2%) were detected after a median follow-up of 7.6 years (up to July 1, 2003). Cancer detection rates during the follow-up period in relation to PSA levels were as follows: 0 to 0.49 ng/mL, 0% (0/958); 0.50 to 0.99 ng/ mL, 0.9% (17/1992); 1.00 to 1.49 ng/mL, 4.7% (54/ 1138); 1.50 to 1.99 ng/mL, 12.3% (70/571); 2.00 to 2.49 ng/mL, 21.4% (67/313); 2.50 to 2.99 ng/mL, 25.2% (56/222); 3.00 to 3.99 ng/mL, 33.3% (89/267); 4.00 to 6.99 ng/mL, 38.9% (103/265); 7.00 to 9.99 ng/mL, 50.0% (30/60); and for men with an initial PSA of 10.00 ng/mL or higher, 76.8% (53/69). Not a single case of prostate cancer was detected within 3 years in 2950 men (50.4% of the screened population) with an initial PSA level less than 1 ng/mL.Conclusions: Retesting intervals should be individualized on the basis of the PSA level, and the large group of men with PSA levels of less than 1 ng/mL can safely be scheduled for a 3-year testing interval.