Positive predictive value of prostate biopsy indicated by prostate-specific-antigen-based prostate cancer screening: trends over time in a European randomized trial
Positive predictive value of prostate biopsy indicated by prostate-specific-antigen-based prostate cancer screening: trends over time in a European randomized trial
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DOI：
10.1111/j.1464-410x.2012.11481.x
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发表时间：
2012-12-01
影响因子：
4.5
通讯作者：
Roobol, Monique J.
中科院分区：
文献类型：
--
作者：
Bokhorst, Leonard P.;Zhu, Xiaoye;Roobol, Monique J.
在欧洲前列腺癌筛查随机研究（ERSPC）的鹿特丹部分，评估前列腺活检的阳性预测值（PPV），由前列腺特异性抗原（PSA）阈值≥ 3.0 ng/mL表示，随着时间的推移。从人口登记中识别的人被随机分配到筛查组或对照组，ERSPC的男性每隔4年进行一次PSA筛查。总共评估了三轮筛选;因此，只有第一次筛查时年龄为55 - 69岁的男性才有资格参加本研究。在随后的三次筛查中，既往未进行活检的男性的TSPPV值保持不变（分别为25.5%、22.3%和24.8%）。相反，既往活检阴性的男性的PPV显著下降（第二次和第三次筛查时分别为12.0%和15.2%）。此外，在既往有和无活检的男性中，侵袭性前列腺癌的百分比（临床分期> T2 b，Gleason评分=7）从第一轮筛选后的44.4%降至第二轮筛选后的23.8%。第三轮为18.6%（P < 0.001）重复活检占全部活检的24.6%，但仅占所有侵袭性癌症的8.6%。在先前未活检的男性中，基于筛查的PPV仍然相等。在先前活检阴性的男性中，PPV显著下降，但20%的癌症检测仍显示出侵袭性特征。个体化筛查算法应将先前的活检状态纳入重复活检的决定中，以进一步减少不必要的活检。
OBJECTIVETo assess the positive predictive value (PPV) of prostate biopsy, indicated by a prostate-specific antigen (PSA) threshold of =3.0 ng/mL, over time, in the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC).PATIENTS AND METHODSIn the Rotterdam section of the ERSPC, a total of 42 376 participants, aged 5574 years, identified from population registries were randomly assigned to a screening or control arm.For the ERSPC men undergo PSA screening at 4-year intervals. A total of three screening rounds were evaluated; therefore, only men aged 5569 years at the first screening were eligible for the present study.RESULTSPPVs for men without previous biopsy remained equal throughout the three subsequent screenings (25.5, 22.3 and 24.8% respectively).Conversely, PPVs for men with a previous negative biopsy dropped significantly (12.0 and 15.2% at the second and third screening, respectively).Additionally, in men with and without previous biopsy, the percentage of aggressive prostate cancers (clinical stage >T2b, Gleason score =7) decreased after the first round of screening from 44.4 to 23.8% in the second (P < 0.001) and 18.6% in the third round (P < 0.001).Repeat biopsies accounted for 24.6% of all biopsies, but yielded only 8.6% of all aggressive cancers.CONCLUSIONSIn consecutive screening rounds the PPV of PSA-based screening remains equal in previously unbiopsied men.In men with a previous negative biopsy the PPV drops considerably, but 20% of cancers detected still show aggressive characteristics.Individualized screening algorithms should incorporate previous biopsy status in the decision to perform a repeat biopsy with the aim of further reducing unnecessary biopsies.