Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter
Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter
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DOI：
10.1056/nejmoa031918
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发表时间：
2004-05-27
影响因子：
158.5
通讯作者：
Coltman, CA
中科院分区：
文献类型：
--
作者：
Thompson, IM;Pauler, DK;Coltman, CA
背景：前列腺特异性抗原（PSA）正常范围的最佳上限尚不清楚。我们调查了前列腺癌预防试验中PSA水平为4.0 ng / ml或更低的男性中前列腺癌的患病率。方法：在预防试验的18882名男性中，9459名被随机分配接受安慰剂，并每年测量PSA和直肠指检。在9459名男性中，2950名男性的PSA水平从未超过每毫升4.0 ng或直肠指检异常，在研究7年后进行了PSA最终测定，并进行了前列腺活检。结果：在2950名男性（年龄范围62 - 91岁）中，449名（15.2%）被诊断为前列腺癌；这449例癌症中有67例（14.9%）的Gleason评分为7或更高。前列腺癌的患病率在PSA水平高达每毫升0.5纳克的男性中为6.6%，在每毫升0.6至1.0纳克的男性中为10.1%，在每毫升1.1至2.0纳克的男性中为17.0%，在每毫升2.1至3.0纳克的男性中为23.9%，在每毫升3.1至4.0纳克的男性中为26.9%。高级别癌症的患病率从与PSA水平为0.5 ng / ml或更低相关的癌症的12.5%增加到与PSA水平为3.1至4.0 ng / ml相关的癌症的25.0%。结论：活检检测到的前列腺癌，包括高级别癌症，在PSA水平为4.0 ng / ml或更低的男性中并不罕见，这通常被认为是在正常范围内。
BACKGROUND:The optimal upper limit of the normal range for prostate-specific antigen (PSA) is unknown. We investigated the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng per milliliter or less.METHODS:Of 18,882 men enrolled in the prevention trial, 9459 were randomly assigned to receive placebo and had an annual measurement of PSA and a digital rectal examination. Among these 9459 men, 2950 men never had a PSA level of more than 4.0 ng per milliliter or an abnormal digital rectal examination, had a final PSA determination, and underwent a prostate biopsy after being in the study for seven years.RESULTS:Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per milliliter, 17.0 percent among those with values of 1.1 to 2.0 ng per milliliter, 23.9 percent among those with values of 2.1 to 3.0 ng per milliliter, and 26.9 percent among those with values of 3.1 to 4.0 ng per milliliter. The prevalence of high-grade cancers increased from 12.5 percent of cancers associated with a PSA level of 0.5 ng per milliliter or less to 25.0 percent of cancers associated with a PSA level of 3.1 to 4.0 ng per milliliter.CONCLUSIONS:Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less -- levels generally thought to be in the normal range.