前列腺癌手术后 PSA 值与监测质量之间的关联。,Cancer Medicine

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前列腺癌手术后 PSA 值与监测质量之间的关联。
Cancer Medicine ( IF 2.9 ) Pub Date : 2019-11-05 , DOI: 10.1002/cam4.2663
Christina Hunter Chapman _{1,

2} , Megan E V Caram _{1,

3} , Archana Radhakrishnan ₄ , Alexander Tsodikov ₅ , Curtiland Deville ₆ , Jennifer Burns ₁ , Alexander Zaslavsky ₇ , Michael Chang ₈ , John T Leppert ₉ , Timothy Hofer _{1,

4} , Anne E Sales _{1,

10} , Sarah T Hawley _{1,

4} , Brent K Hollenbeck ₇ , Ted A Skolarus _{1,

7}

Affiliation

Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Hunter Holmes McGuire Veterans Affairs Healthcare System, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System and the Department of Urology, Stanford University, Stanford, CA, USA.
Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.

背景尽管前列腺特异性抗原 (PSA) 检测用于前列腺癌检测和治疗后监测，但这些设置中的阈值不同。4.0 ng/mL 的筛选截止值可能不适用于术后监测，通常使用 0.2 ng/mL，从而错失有效补救放射治疗的机会。我们进行了一项研究，以确定当 PSA 值超过 4 ng/mL 时指南与年度术后 PSA 监测的一致性是否增加，这代表了与手术后无关的筛查阈值。方法我们使用美国退伍军人健康管理局的数据对 2005 年至 2008 年诊断为非转移性前列腺癌并接受根治性前列腺切除术的男性进行回顾性纵向队列研究。我们使用逻辑回归来检查术后 PSA 水平与接受年度 PSA 测试之间的关联。结果在 10400 名男性和 38901 人年的随访中，年度指南一致性从第 1 年的 95% 下降到第 7 年的 79%。调整后，最年轻和最年长的男性、黑人和黑人的指南一致性较低未婚男子。当 PSA 超过 4 ng/mL 时，指南一致性显着增加（调整后的比值比 2.20 PSA > 4-6 ng/mL vs PSA > 1-4 ng/mL，95% 置信区间 1.20-4.03；P = .01）。结论当 PSA 值超过 4 ng/mL 时，指南与前列腺癌监测的一致性增加，这表明前列腺癌手术后的筛查阈值不相关，0.2 ng/mL 被认为是治疗失败，正在影响癌症监测质量。

"点击查看英文标题和摘要"

Association between PSA values and surveillance quality after prostate cancer surgery.

BACKGROUND Although prostate-specific antigen (PSA) testing is used for prostate cancer detection and posttreatment surveillance, thresholds in these settings differ. The screening cutoff of 4.0 ng/mL may be inappropriately used during postsurgery surveillance, where 0.2 ng/mL is typically used, creating missed opportunities for effective salvage radiation treatment. We performed a study to determine whether guideline concordance with annual postoperative PSA surveillance increases when PSA values exceed 4 ng/mL, which represents a screening threshold that is not relevant after surgery. METHODS We used US Veterans Health Administration data to perform a retrospective longitudinal cohort study of men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. We used logistic regression to examine the association between postoperative PSA levels and receipt of an annual PSA test. RESULTS Among 10 400 men and 38 901 person-years of follow-up, annual guideline concordance decreased from 95% in year 1 to 79% in year 7. After adjustment, guideline concordance was lower for the youngest and oldest men, Black, and unmarried men. Guideline concordance significantly increased as PSA exceeded 4 ng/mL (adjusted odds ratio 2.20 PSA > 4-6 ng/mL vs PSA > 1-4 ng/mL, 95% confidence interval 1.20-4.03; P = .01). CONCLUSIONS Guideline concordance with prostate cancer surveillance increased when PSA values exceeded 4 ng/mL, suggesting a screening threshold not relevant after prostate cancer surgery, where 0.2 ng/mL is considered treatment failure, is impacting cancer surveillance quality. Clarification of PSA thresholds for early detection vs cancer surveillance, as well as emphasizing adherence for younger and Black men, appears warranted.

更新日期：2019-11-06

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