Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study.
Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study.
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DOI：
10.1136/bmj.c4521
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发表时间：
2010-09-14
期刊：
影响因子：
--
通讯作者：
Lilja H
中科院分区：
文献类型：
--
作者：
Vickers AJ;Cronin AM;Björk T;Manjer J;Nilsson PM;Dahlin A;Bjartell A;Scardino PT;Ulmert D;Lilja H
目的探讨未筛查人群60岁时前列腺特异性抗原浓度与随后临床相关前列腺癌诊断的关系，评价前列腺癌筛查和化学预防是否可以按风险分层。设计1:3匹配的病例对照研究，嵌套在一个高度代表性的基于人群的队列研究中。参加马尔默预防项目的瑞典一般人口。国家健康和福利委员会的癌症登记处。参与者是1167名60岁的男性，他们在1981年提供了血液样本，并一直随访到85岁。主要观察指标：前列腺癌转移或死亡。结果在研究过程中筛查率较低。前列腺癌转移43例，死亡35例。60岁前列腺特异性抗原浓度与前列腺癌转移（曲线下面积0.86,95%可信区间0.79 ~ 0.92，P<0.001）和前列腺癌死亡（0.90,0.84 ~ 0.96，P<0.001）相关。曲线下面积（从0到1）的数值越大，测试效果越好。虽然只有少数浓度在前四分之一（20毫微克/毫升）的男性患致命性前列腺癌，但90%（78%至100%）的前列腺癌死亡发生在这些男性身上。相反，浓度在中位或更低（≤1 ng/ml）的60岁男性不太可能患有临床相关的前列腺癌（85岁转移风险为0.5%，前列腺癌死亡风险为0.2%）。结论60岁前列腺特异性抗原浓度可预测前列腺癌转移及死亡风险。虽然浓度低于中位数（≤1ng /ml）的60岁男性可能患有前列腺癌，但不太可能危及生命。这样的男性可以免于进一步的筛查，而应该把重点放在浓度较高的男性身上。
Objective To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. Design Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. Participants 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. Main outcome measures Metastasis or death from prostate cancer. Results The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P<0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). Conclusions The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.
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影响因子：
45.3
作者：
Lilja, Hans;Ulmert, David;Berglund, Goran
通讯作者：
Berglund, Goran
影响因子：
158.5
作者：
Thompson, IM;Pauler, DK;Coltman, CA
通讯作者：
Coltman, CA
影响因子：
10.3
作者：
Haas, Gabriel P.;Delongchamps, Nicolas Barry;de la Roza, Gustavo
通讯作者：
de la Roza, Gustavo
影响因子：
158.5
作者：
Andriole, Gerald L.;Bostwick, David G.;Rittmaster, Roger S.
通讯作者：
Rittmaster, Roger S.
DOI：
10.1056/nejmoa0810696
发表时间：
2009-03-26
期刊：
The New England journal of medicine
影响因子：
--
作者：
Andriole GL;Crawford ED;Grubb RL 3rd;Buys SS;Chia D;Church TR;Fouad MN;Gelmann EP;Kvale PA;Reding DJ;Weissfeld JL;Yokochi LA;O'Brien B;Clapp JD;Rathmell JM;Riley TL;Hayes RB;Kramer BS;Izmirlian G;Miller AB;Pinsky PF;Prorok PC;Gohagan JK;Berg CD;PLCO Project Team
通讯作者：
PLCO Project Team