Prostate specific antigen velocity risk count predicts biopsy reclassification for men with very low risk prostate cancer.
Prostate specific antigen velocity risk count predicts biopsy reclassification for men with very low risk prostate cancer.
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DOI：
10.1016/j.juro.2013.09.029
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发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Carter HB
中科院分区：
文献类型：
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作者：
Patel HD;Feng Z;Landis P;Trock BJ;Epstein JI;Carter HB
在积极监测低风险前列腺癌的患者中，前列腺特异性抗原速度是不可靠的预测不良病理结果的指标。然而，据我们所知，最近在筛查队列中验证的名为前列腺特异性抗原速度风险计数的新概念尚未在积极的监测队列中进行研究。我们评估了从1995年到2012年的一组前列腺癌患者，并进行了积极的监测。全部病例均为T1c期，前列腺特异性抗原密度<0.15 ng/ml，Gleason评分<6分，活检点数2个或以下，肿瘤累及50%或以下。这些男性通过半年一次的前列腺特异性抗原测量、直肠指诊和年度监测活检来观察。建议将治疗用于活组织检查重新分类。应用Logistic回归分析、Cox比例风险分析、Kaplan-Meier分析和包括ROC曲线的AUC在内的性能参数，对随访30个月以上、连续3次测定前列腺特异性抗原速度的患者进行初步分析。初步分析包括668名符合极低风险纳入标准的男性中的275人，其中83人(30.2%)重新分类，中位数为57.1个月。重新分类风险随着风险计数的增加而增加，即与零相比，风险计数为3(HR 4.63，95%CI 1.54-13.87)和2(HR 3.73，95%CI 1.75-7.97)。Gleason评分结果相似(HR 7.45，95%CI 1.60~34.71和3.96，95%CI 1.35~11.62)。在二次分析中，第二年重新分类的阴性预测值(风险计数1或更小)为91.5%。在包括基线前列腺特异性抗原密度(0.7423比0.6818，p=0.025)的模型中，添加前列腺特异性抗原速度风险计数改善了AUC值，并且优于添加总前列腺特异性抗原速度(0.7423 vs0.6960，p=0.037)。前列腺特异性抗原速度风险计数可能有助于监测患者的主动监测，并减少长期所需的活检频率。
Prostate specific antigen velocity is an unreliable predictor of adverse pathology findings in patients on active surveillance for low risk prostate cancer. However, to our knowledge a new concept called prostate specific antigen velocity risk count, recently validated in a screening cohort, has not been investigated in an active surveillance cohort. We evaluated a cohort of men from 1995 to 2012 with prostate cancer on active surveillance. They had stage T1c disease, prostate specific antigen density less than 0.15 ng/ml, Gleason score 6 or less, 2 or fewer biopsy cores and 50% or less involvement of any core with cancer. The men were observed by semiannual prostate specific antigen measurements, digital rectal examinations and an annual surveillance biopsy. Treatment was recommended for biopsy reclassification. Patients with 30 months or greater of followup and 3 serial prostate specific antigen velocity measurements were used in primary analysis by logistic regression, Cox proportional hazards, Kaplan-Meier analysis and performance parameters, including the AUC of the ROC curve. Primary analysis included 275 of 668 men who met very low risk inclusion criteria, of whom 83(30.2%) were reclassified at a median of 57.1 months. Reclassification risk increased with risk count, that is a risk count of 3 (HR 4.63, 95% CI 1.54–13.87) and 2 (HR 3.73, 95% CI 1.75–7.97) compared to zero. Results were similar for Gleason score reclassification (HR 7.45, 95% CI 1.60–34.71 and 3.96, 95% CI 1.35–11.62, respectively). On secondary analysis the negative predictive value (risk count 1 or less) was 91.5% for reclassification in the next year. Adding the prostate specific antigen velocity risk count improved the AUC in a model including baseline prostate specific antigen density (0.7423 vs 0.6818, p = 0.025) and it outperformed the addition of overall prostate specific antigen velocity (0.7423 vs 0.6960, p = 0.037). Prostate specific antigen velocity risk count may be useful for monitoring patients on active surveillance and decreasing the frequency of biopsies needed in the long term.