Optimal Starting Age and Baseline Level for Repeat Tests: Economic Concerns of PSA Screening for Chinese Men-10-Year Experience of a Single Center
Optimal Starting Age and Baseline Level for Repeat Tests: Economic Concerns of PSA Screening for Chinese Men-10-Year Experience of a Single Center
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重复检测的最佳起始年龄和基线水平：中国男性 PSA 筛查的经济问题 - 单一中心 10 年经验。
DOI：
10.1159/000503733
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发表时间：
2020-05-01
影响因子：
1.6
通讯作者：
Chen, Ming-Kun
中科院分区：
文献类型：
--
作者：
Liu, Yang;Xiao, Gang;Chen, Ming-Kun
目的：在中国单中心研究基线血清前列腺特异性抗原（PSA）检测和重复筛查的最佳年龄及其经济负担。材料和方法：35,533例PSA筛查男性回顾性入组本研究。对1,586名PSA >4 ng/mL的男性进行随访，并采用受试者工作特征（ROC）曲线研究最佳截止值。结果如下：ROC曲线分析表明，PSA初筛的最佳年龄为57.5岁（AUC = 0.84），62.5岁（AUC = 0.902），60.5年（AUC = 0.909）和61.5年对于PSA >4和>10 ng/mL、诊断为前列腺癌（PCa）和定义为病灶事件的临床显著PCa的个体，分别使用AUC = 0.890。对于50-59岁、60-69岁和>70岁的中国男性，初始PSA水平为1.305 ng/mL（AUC = 0.699）、1.975 ng/mL（AUC = 0.711）和2.740 ng/mL（AUC = 0.720）的患者，随访期间PSA速率可能>0.75 ng/mL/年。总费用为CNY 13，609，260元，但35，533人中仅有60人（0.17%）从PSA筛查中获益。结论：我们认为，初次PSA检测的最佳起始年龄为57.5岁。重复筛查的必要性应基于第一个PSA水平，取决于年龄。基于人口的筛查应包括成本效益分析。
Objective: To investigate the optimal age for the baseline serum prostate-specific antigen (PSA) test and for repeat screening and its economic burden in a single center in China. Materials and Methods: 35,533 men with PSA screening were retrospectively enrolled in this study. Follow-ups were conducted in 1,586 men with PSA >4 ng/mL, and receiver-operating characteristic (ROC) curves were employed to investigate the optimal cutoffs. Results: ROC analysis indicated that the optimal age for initial PSA screening was 57.5 years (AUC = 0.84), 62.5 years (AUC = 0.902), 60.5 years (AUC = 0.909), and 61.5 years (AUC = 0.890) for individuals with PSA >4 and >10 ng/mL, a diagnosis of prostate cancer (PCa), and clinically significant PCa defined as the focus events, respectively. For Chinese men aged 50-59, 60-69, and >70 years, the initial PSA levels of 1.305 ng/mL (AUC = 0.699), 1.975 ng/mL (AUC = 0.711), and 2.740 ng/mL (AUC = 0.720) might have a PSA velocity >0.75 ng/mL per year during the follow-up. In addition, the total cost amounts to CNY 13,609,260 in these cases, but only 60 of the 35,533 (0.17%) men gained benefit from PSA screening. Conclusion: In our opinion, the optimal starting age for initial PSA testing was 57.5 years. The necessity for repeat screening should be based on the first PSA level depending on age. A cost--benefit analysis should be included in population-based screening.