Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer.
Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer.
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DOI：
10.3389/fonc.2016.00157
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发表时间：
2016
影响因子：
4.7
通讯作者：
Neville TB
中科院分区：
文献类型：
--
作者：
MacKintosh FR;Sprenkle PC;Walter LC;Rawson L;Karnes RJ;Morrell CH;Kattan MW;Nawaf CB;Neville TB
在年轻男性中，早期前列腺特异性抗原(PSA)水平与前列腺癌诊断和死亡的可能性更高相关。老年男性的PSA检测一直被认为用处有限。我们评估了前列腺癌死亡率与年龄和前列腺癌确诊前PSA水平的关系。使用退伍军人事务部数据库，我们确定了230,081名年龄在50-89 之间的男性被诊断患有前列腺癌，并在1999年至2009年期间至少进行了一次前列腺癌检测。使用卡普兰-迈耶方法，根据年龄组(例如，50-59 岁至80-89 岁)和确诊时PSA值范围(10个范围)，计算前列腺癌特定死亡率随时间的变化。对不同年龄和PSA的10年前列腺癌死亡率进行了对数等级检验，并对多次检验进行了Bonferroni调整。在10年的研究期间(平均随访 = 为3.7 年)，被诊断为前列腺癌的男性中有10.5%死于癌症。诊断前较高的PSA值预示着所有年龄组的死亡风险都较高(p <； 0.0001)。在相同的前列腺特异性抗原范围内，年龄较大的人群死于前列腺癌的风险增加(p <； 0.0001)。当PSA值为7-10 ng/m L时，确诊后10 年的癌症特异性死亡率从50-59 岁的7%上升到80-89 岁的51%。在任何 水平上，70岁以上的男性死于前列腺癌的可能性都比年轻男性更高，这表明前列腺癌在老年男性(即使是80岁以上的男性)中仍然是一个严重的问题，值得进一步研究。
A single early prostate-specific antigen (PSA) level has been correlated with a higher likelihood of prostate cancer diagnosis and death in younger men. PSA testing in older men has been considered of limited utility. We evaluated prostate cancer death in relation to age and PSA level immediately prior to prostate cancer diagnosis. Using the Veterans Affairs database, we identified 230,081 men aged 50–89 years diagnosed with prostate cancer and at least one prior PSA test between 1999 and 2009. Prostate cancer-specific death over time was calculated for patients stratified by age group (e.g., 50–59 years, through 80–89 years) and PSA range at diagnosis (10 ranges) using Kaplan–Meier methods. Risk of 10-year prostate cancer mortality across age and PSA was compared using log-rank tests with a Bonferroni adjustment for multiple testing. 10.5% of men diagnosed with prostate cancer died of cancer during the 10-year study period (mean follow-up = 3.7 years). Higher PSA values prior to diagnosis predict a higher risk of death in all age groups (p < 0.0001). Within the same PSA range, older age groups are at increased risk for death from prostate cancer (p < 0.0001). For PSA of 7–10 ng/mL, cancer-specific death, 10 years after diagnosis, increased from 7% for age 50–59 years to 51% for age 80–89 years. Men older than 70 years are more likely to die of prostate cancer at any PSA level than younger men, suggesting prostate cancer remains a significant problem among older men (even those aged 80+) and deserves additional study.