Background

Prostate-specific antigen (PSA) screening reduces prostate cancer deaths but leads to harm from overdiagnosis and overtreatment.

Objective

To determine the long-term risk of prostate cancer mortality using kallikrein blood markers measured at baseline in a large population of healthy men to identify men with low risk for prostate cancer death.

Design, setting, participants

Study based on the Malmö Diet and Cancer cohort enrolling 11 506 unscreened men aged 45–73 yr during 1991–1996, providing cryopreserved blood at enrollment and followed without PSA screening to December 31, 2014. We measured four kallikrein markers in the blood of 1223 prostate cancer cases and 3028 controls.

Outcome measurements and statistical analysis

Prostate cancer death (n = 317) by PSA and a prespecified statistical model based on the levels of four kallikrein markers.

Results and limitations

Baseline PSA predicted prostate cancer death with a concordance index of 0.86. In men with elevated PSA (≥2.0 ng/ml), predictive accuracy was enhanced by the four-kallikrein panel compared with PSA (0.80 vs 0.73; improvement 0.07; 95% confidence interval 0.04, 0.10). Nearly half of men aged 60+ yr with elevated PSA had a four-kallikrein panel score of <7.5%, translating into 1.7% risk of prostate cancer death at 15 yr—a similar estimate to that of a man with a PSA of 1.6 ng/ml. Men with a four-kallikrein panel score of ≥7.5% had a 13% risk of prostate cancer death at 15 yr.

Conclusions

A prespecified statistical model based on four kallikrein markers (commercially available as the 4Kscore) reclassified many men with modestly elevated PSA, to have a low long-term risk of prostate cancer death. Men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy.

Patient summary

Men with elevated prostate-specific antigen (PSA) are often referred for prostate biopsy. However, men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy.

中文翻译：

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由中年前列腺特异性抗原和一组基于大量健康人群的激肽释放酶标记物组成的一组的前列腺癌死亡的二十年风险

背景

前列腺特异性抗原（PSA）筛查可减少前列腺癌的死亡，但会因过度诊断和过度治疗而造成伤害。

客观的

为了确定在大量健康男性中使用激肽释放酶血液标志物在基线时测得的前列腺癌死亡的长期风险，以鉴定前列腺癌死亡风险低的男性。

设计，设置，参与者

这项研究是基于1991年至1996年间在马尔默饮食与癌症研究小组中招募的11506名年龄在45-73岁之间的未筛查男性进行的研究，入组时提供了冷冻保存的血液，随后未进行PSA筛查至2014年12月31日。我们测量了1223年血液中的四种激肽释放酶标记物前列腺癌病例和3028名对照。

成果测量和统计分析

 通过PSA和基于四种激肽释放酶标记物水平的预先确定的统计模型，确定前列腺癌死亡（n = 317）。

结果与局限性

基线PSA预测一致性指数为0.86的前列腺癌死亡。在PSA升高（≥2.0ng / ml）的男性中，四激肽释放酶组与PSA相比提高了预测准确性（0.80 vs 0.73；改善0.07； 95％置信区间0.04，0.10）。60岁以上的PSA升高的男性中，有近一半的四激肽释放酶评分低于7.5％，这意味着15岁时前列腺癌死亡的风险为1.7％，与PSA为1.6 ng的男性相似。 /毫升。四激肽释放酶面板得分≥7.5％的男性在15岁时有13％的前列腺癌死亡风险。

结论

一种基于四种激肽释放酶标记物（可作为4Kscore购得）的预先确定的统计模型将许多PSA轻度升高的男性重新分类为前列腺癌死亡的长期风险较低。PSA升高但四激肽释放酶评估小组评分较低的男性可以进行监测，而无需进行活检。

病人总结

前列腺特异性抗原（PSA）升高的男性通常被要求进行前列腺穿刺活检。但是，可以监测PSA升高但四激肽释放酶评估小组得分较低的男性，而不需要进行活检。