Variation of serum prostate-specific antigen levels - An evaluation of year-to-year fluctuations
Variation of serum prostate-specific antigen levels - An evaluation of year-to-year fluctuations
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DOI：
10.1001/jama.289.20.2695
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发表时间：
2003-05-28
影响因子：
120.7
通讯作者：
Begg, CB
中科院分区：
文献类型：
--
作者：
Eastham, JA;Riedel, E;Begg, CB
背景血清前列腺特异性抗原（PSA）检测常用于前列腺癌的早期检测。虽然PSA检测已导致前列腺癌检出率的增加，但由于缺乏特异性，其常规使用受到质疑。目的确定PSA水平的逐年波动是否是由于自然变化，并使单一PSA检测结果不可靠。设计、设置和参与者对972名未经筛查的男性人群进行回顾性分析（中位年龄，62岁）参与息肉预防试验（1991-1998）。在4年的时间内连续采集5份血液样本，并评估总PSA和游离PSA水平。主要结果测量基于PSA水平高于4 ng/mL、PSA水平高于2.5 ng/mL、PSA水平高于年龄特异性临界值、PSA水平在4 - 10 ng/mL范围内且游离PSA与总PSA之比小于0.25 ng/mL的PSA检测结果异常;结果前列腺穿刺活检在PSA水平高于4 ng/mL的207例（21%）、PSA水平高于2.5ng/mL的358例（37%）、PSA水平高于年龄特异性临界值的172例（18%）中均被推荐。190例（20%）的水平在4 - 10 ng/mL之间，游离/总比值小于0.25 ng/mL; 145例（15%）的速度高于每年0.75 ng/mL。在PSA异常的男性中，在4年随访期间的1次或多次后续访视中，PSA正常的比例很高：154名参与者中有68名（44%）PSA水平高于4 ng/mL; 291名参与者中有116名（40%）PSA水平高于2.5 ng/mL; 117名参与者中有64名（55%）PSA水平高于年龄特异性临界值; 143例中有76例（53%）PSA水平在4 ~ 10 ng/mL之间，游离/总比值小于0.25 ng/mL。
Context Serum prostate-specific antigen (PSA) testing is frequently used in early detection programs for prostate cancer. While PSA testing has resulted in an increase in prostate cancer detection, its routine use has been questioned because of a lack of specificity.Objective To determine whether year-to-year fluctuations in PSA levels are due to natural variation and render a single PSA test result unreliable.Design, Setting, and Participants Retrospective analysis of an unscreened population of 972 men (median age, 62 years) participating in the Polyp Prevention Trial (1991-1998). Five consecutive blood samples were obtained during a 4-year period and were assessed for total and free PSA levels.Main Outcome Measure Abnormal PSA test result based on a PSA level higher than 4 ng/mL; a PSA level higher than 2.5 ng/mL; a PSA level above the age-specific cutoff; a PSA level in the range of 4 to 10 ng/mL and a free-to-total ratio of less than 0.25 ng/mL; or a PSA velocity higher than 0.75 ng/mL per year.Results Prostate biopsy would have been recommended in 207 participants (21%) with a PSA level higher than 4 ng/mL; in 358 (37%) with a level higher than 2.5 ng/mL; in 172 (18%) with a level above the age-specific cutoff; in 190 (20%) with a level between 4 and 10 ng/mL and a free-to-total ratio of less than 0.25 ng/mL; and in 145 (15%) with a velocity higher than 0.75 ng/mL per year. Among men with an abnormal PSA finding, a high proportion had a normal PSA finding at 1 or more subsequent visits during 4-year follow-up: 68 (44%) of 154 participants with a PSA level higher than 4 ng/mL; 116 (40%) of 291 had a level higher than 2.5 ng/mL; 64 (55%) of 117 had an elevated level above the age-specific cutoff; and 76 (53%) of 143 had a level between 4 and 10 ng/mL and a free-to-total ratio of less than 0.25 ng/mL.Conclusion An isolated elevation in PSA level should be confirmed several weeks later before proceeding with further testing, including prostate biopsy.