PURPOSE Our goal was to quantify the ability of various PSA values in predicting the likelihood of developing metastatic or fatal prostate cancer in older men. MATERIALS AND METHODS We used a random sample of patients in the US Veterans Health Administration to identify 80,706 men who had received PSA testing between ages 70 to 75. Our primary end point was time to development of either metastatic prostate cancer or death from prostate cancer. We used cumulative/dynamic modeling to account for competing events (death from non-prostate cancer causes) in studying both the discriminative ability of PSA as well as for positive predictive value and negative predictive value at 3 time points. RESULTS PSA demonstrated time-dependent predictive discrimination, with receiver operating characteristic area under the curve at 5, 10, and 14 years decreasing from 0.83 to 0.77 to 0.73, respectively, but without statistically significant difference when stratified by race. At PSA thresholds between 1 and 8 ng/mL, the positive predictive value of developing advanced prostate cancer was significantly greater in Black than White patients. For instance, at a PSA > 3, at 5, 10, and 14 years, White patients had 2.4%, 2.9%, and 3.7% risk of an event, whereas Black patients had 4.3%, 6.5%, and 8.3% risk. CONCLUSIONS In men aged 70 to 75 deciding whether to cease PSA testing with borderline-elevated PSA values, the risk of developing metastatic or fatal prostate cancer is quantifiable and relatively low. Risk assessment in this setting must account for the higher incidence of prostate cancer in Black men.

中文翻译：

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前列腺特异性抗原分层用于预测接近推荐筛查年龄限制的男性的晚期前列腺癌事件。


目的 我们的目标是量化各种 PSA 值预测老年男性发生转移性或致命性前列腺癌的可能性的能力。材料和方法我们使用美国退伍军人健康管理局的患者随机样本来确定 80,706 名年龄在 70 至 75 岁之间接受过 PSA 检测的男性。我们的主要终点是发生转移性前列腺癌或死于前列腺癌的时间。在研究 PSA 的鉴别能力以及 3 个时间点的阳性预测值和阴性预测值时，我们使用累积/动态模型来解释竞争事件 （非前列腺癌原因导致的死亡）。结果 PSA 表现出时间依赖性预测区分，受试者在 5 、 10 和 14 岁时的曲线下工作特征面积分别从 0.83 下降到 0.77 到 0.73，但按种族分层时没有统计学意义差异。当 PSA 阈值在 1 至 8 ng/mL 之间时，黑人患者发展为晚期前列腺癌的阳性预测值显著高于白人患者。例如，在 PSA > 3 时，在 5 、 10 和 14 岁时，白人患者发生事件的风险为 2.4% 、 2.9% 和 3.7%，而黑人患者的风险为 4.3% 、 6.5% 和 8.3%。结论在 70 至 75 岁的男性中，当 PSA 值临界升高时决定是否停止 PSA 检测时，发生转移性或致命性前列腺癌的风险是可量化的且相对较低。在这种情况下，风险评估必须考虑到黑人男性前列腺癌发病率较高。