The Role of Baseline Prostate-specific Antigen Value Prior to Age 60 in Predicting Lethal Prostate Cancer: Analysis of a Contemporary North American Cohort.

IF 8.3 1区 医学 Q1 ONCOLOGY
European urology oncology Pub Date : 2024-12-01 Epub Date: 2024-07-10 DOI:10.1016/j.euo.2024.06.014
Marco Finati, Matthew Davis, Alex Stephens, Giuseppe Chiarelli, Giuseppe Ottone Cirulli, Chase Morrison, Rafe Affas, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Alberto Briganti, Francesco Montorsi, Giuseppe Carrieri, Craig Rogers, Andrew Julian Vickers, Firas Abdollah
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引用次数: 0

Abstract

Background and objective: Studies evaluating the role of baseline midlife prostate-specific antigen (PSA) as a predictor of development and progression of prostate cancer relied predominately on cohorts from the pre-PSA screening introduction era. The aim of our study was to examine the role of baseline PSA prior to the age of 60 yr as a predictor of developing lethal prostate cancer using a contemporary North American cohort.

Methods: Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer.

Key findings and limitations: A total of 129067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSA

Conclusions and clinical implications: Baseline PSA is a very strong predictor of the subsequent risk of developing lethal prostate cancer in a large contemporary diverse North American cohort, which was exposed to opportunistic PSA screening. The association was far larger than that found for polygenic risk scores, confirming that baseline PSA prior to the age of 60 yr is the most effective tool for adjusting subsequent screening. Compared with studies of unscreened cohorts, there was a smaller difference in discrimination between incident and lethal disease, reflecting the influence of screening.

Patient summary: In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing.

60 岁前前列腺特异抗原基线值在预测致命前列腺癌中的作用:对当代北美队列的分析。
背景和目的:评估中年基线前列腺特异性抗原(PSA)对前列腺癌的发生和发展的预测作用的研究主要依赖于引入前列腺特异性抗原筛查前的队列。我们的研究旨在利用当代北美队列研究 60 岁之前的前列腺特异性抗原基线对致命性前列腺癌的预测作用:我们的队列包括 1995 年至 2019 年期间通过医疗系统接受首次 PSA 检查的所有 40-59 岁男性。根据年龄将患者分为四类:40-44 岁、45-49 岁、50-54 岁和 55-59 岁。致命疾病是指在诊断时或随访期间死于前列腺癌或出现转移性疾病。癌症特异性死亡率和总死亡率是通过将我们的数据库与密歇根州生命记录登记系统相连接而获得的。竞争风险回归用于评估PSA与致死性前列腺癌之间的关系:在研究期间,共有129067名男性符合纳入标准。对于 40-44 岁、45-49 岁、50-54 岁和 55-59 岁的男性,PSA 患者在 20 年后的致死性前列腺癌发生率估计分别为 0.02%、0.14%、0.33% 和 0.51% 结论和临床意义:在一个大型的当代多样化北美队列中,基线 PSA 是预测随后罹患致死性前列腺癌风险的一个非常有力的指标,该队列接受了机会性 PSA 筛查。这种关联远大于多基因风险评分,证实了 60 岁之前的基线 PSA 是调整后续筛查的最有效工具。与未接受筛查的队列研究相比,发病和致死疾病之间的鉴别差异较小,这反映了筛查的影响。患者总结:在这项研究中,我们发现单一的前列腺特异性抗原(PSA)基线值可有力地预测随后罹患转移性前列腺癌的风险以及死于前列腺癌的风险。因此,最初的前列腺特异性抗原(PSA)水平可用于调整随后的前列腺特异性抗原(PSA)检测频率。
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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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