Making sense of prostate specific antigen: improving its predictive value in patients undergoing prostate biopsy
Autor: | Greg Pond, John Trachtenberg, Robert K. Nam, Marjan Emami, Joan Sweet, Michael A.S. Jewett, Steven A. Narod, Ants Toi, Linda Sugar, Laurence Klotz |
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Rok vydání: | 2005 |
Předmět: |
Adult
Male medicine.medical_specialty Prostate biopsy Urology Biopsy urologic and male genital diseases Prostate cancer Prostate Lower urinary tract symptoms Predictive Value of Tests Risk Factors Medicine Humans High-grade prostatic intraepithelial neoplasia Aged Digital Rectal Examination Aged 80 and over medicine.diagnostic_test business.industry Prostatic Neoplasms Middle Aged Prostate-Specific Antigen medicine.disease Prostate-specific antigen medicine.anatomical_structure Prostate cancer screening Transrectal ultrasonography business |
Zdroj: | The Journal of urology. 175(2) |
ISSN: | 0022-5347 |
Popis: | The clinical usefulness of PSA for prostate cancer screening is unclear, although the test remains in common use. New methods to interpret PSA are needed.We examined a cohort of 2,637 men who underwent prostate biopsies for abnormal DRE or PSA between 1999 and 2004. Using risk factors for prostate cancer, including patient age, ethnicity, family history of prostate cancer, previous negative biopsy, voiding symptoms and prostate volume, we developed risk groups for prostate cancer using recursive partitioning modeling independent of PSA or DRE. We then compared prostate cancer probabilities by PSA ranges by risk group.Of the 2,637 men 1,282 (48.6%) had prostate cancer. Age, ethnicity, family history, previous negative biopsy and prostate volume were predictive for cancer. We constructed 6 risk groups by combining these factors and created tables to assign patients to these groups. Independent of PSA and DRE the probability of cancer ranged from 15% in patients in group 1 to 78% in patients in group 6 (p0.0001). By adding PSA and DRE to each risk group prostate cancer probabilities were refined from 0% to 100%. Patients in the higher risk groups also had higher grade cancer (p0.0001).We generated 6 risk groups based on simple risk factors for prostate cancer. When used in the right context and patient, PSA is highly accurate for predicting prostate cancer and permitting rational decision making in patients with abnormal PSA. |
Databáze: | OpenAIRE |
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