Assessing prostate cancer risk: Results from the prostate cancer prevention trial
Assessing prostate cancer risk: Results from the prostate cancer prevention trial
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DOI：
10.1093/jnci/djj131
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发表时间：
2006-04-19
期刊：
影响因子：
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通讯作者：
Coltman, CA
中科院分区：
文献类型：
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作者：
Thompson, IM;Ankerst, DP;Coltman, CA
在美国，前列腺特异性抗原（PSA）检测是诊断前列腺癌的主要方法。需要将其他与前列腺癌相关的危险因素纳入个体化风险预测。我们利用参加前列腺癌预防试验（PCPT）的男性的前列腺活检数据来建立前列腺癌的预测模型。方法：我们纳入了5519名接受前列腺活检的PCPT安慰剂组的男性。在活检前一年至少进行一次PSA测量和直肠指检（DRE），并且在前列腺活检前3年内至少进行两次PSA测量。采用Logistic回归对前列腺癌和高度病变的风险与活检年龄、种族、前列腺癌家族史、PSA水平、PSA速度、DRE结果和既往前列腺活检相关进行建模。根据估计的逻辑回归模型建立风险方程。所有统计检验均为双侧检验。结果：1211例（21.9%）男性通过前列腺活检诊断为前列腺癌。预测前列腺癌的变量包括较高的PSA水平、前列腺癌阳性家族史和异常的DRE结果，而既往前列腺活检阴性与风险降低相关。活检年龄和PSA速度都不能提供独立的预后信息。较高的PSA水平、异常的DRE结果、活检时年龄较大和非裔美国人种族是高级别疾病的预测因素（Gleason评分>= 7），而先前的前列腺活检阴性则降低了这种风险。结论：该预测模型允许对接受前列腺活检的男性进行前列腺癌风险和高级别疾病风险的个体化评估。
Prostate-specific antigen (PSA) testing is the primary method used to diagnose prostate cancer in the United States. Methods to integrate other risk factors associated with prostate cancer into individualized risk prediction are needed. We used prostate biopsy data from men who participated in the Prostate Cancer Prevention Trial (PCPT) to develop a predictive model of prostate cancer. Methods: We included 5519 men from the placebo group of the PCPT who underwent prostate biopsy., had at least one PSA measurement and a digital rectal examination (DRE) performed during the year before the biopsy, and had at least two PSA measurements performed during the 3 years before the prostate biopsy. Logistic regression was used to model the risk of prostate cancer and high-grade disease associated with age at biopsy, race, family history of prostate cancer, PSA level, PSA velocity, DRE result, and previous prostate biopsy. Risk equations were created from the estimated logistic regression models. All statistical tests were two-sided. Results: A total of 1211 (21.9%) men were diagnosed with prostate cancer by prostate biopsy. Variables that predicted prostate cancer included higher PSA level, positive family history of prostate cancer, and abnormal DRE result, whereas a previous negative prostate biopsy was associated with reduced risk. Neither age at biopsy nor PSA velocity contributed independent prognostic information. Higher PSA level, abnormal DRE result, older age at biopsy, and African American race were predictive for high-grade disease (Gleason score >= 7) whereas a previous negative prostate biopsy reduced this risk. Conclusions: This predictive model allows an individualized assessment of prostate cancer risk and risk of high-grade disease for men who undergo a prostate biopsy.