Purpose

Older men have higher prostate-specific antigen levels than younger men. However, the current Japanese Urological Association guidelines recommend secondary screening at a cutoff value of 4.0 ng/mL, even in older men. Here, we reexamined the cutoffs for older men using a prostate screening cohort in Japan and first performed an analysis to determine the indication cutoffs for detecting positive biopsies.

Methods

Data from 68,566 prostate cancer screenings in the city in 2018 were combined with cancer registration data. The optimal prostate-specific antigen levels to predict prostate cancer in different age groups were calculated using receiver operating characteristic curves after determining whether a cancer was registered within one year of screening.

Results

At the conventional prostate-specific antigen threshold of 4.0 ng/mL, the sensitivity, specificity, and negative predictive value were 94.9%, 91.7%, and 91.7%, respectively. The optimal prostate-specific antigen cutoff values for patients aged 50–59 years, 60–69 years, 70–79 years, and over 80 years were 3.900 ng/mL, 4.014 ng/mL, 4.080 ng/mL, and 4.780 ng/mL, respectively.

Conclusions

The sensitivity and specificity of prostate cancer screening in the city were high, indicating a highly accurate screening. The prostate-specific antigen threshold was 4.78 ng/mL in patients older than 80 years. A higher prostate-specific antigen threshold may be useful in men over 80 years of age to avoid excess biopsy and reduce costs. Our results suggest that the current Japanese method of using PSA 4.0 ng/mL as a cutoff regardless of age may not be preferable for older men.

中文翻译：

---

日本某城市的前列腺癌筛查：年龄特异性前列腺特异性抗原截止阈值

目的

老年男性比年轻男性具有更高的前列腺特异性抗原水平。然而，当前的日本泌尿外科协会指南建议，即使在老年男性中，也应以 4.0 ng/mL 的临界值进行二次筛查。在这里，我们使用日本的前列腺筛查队列重新检查了老年男性的截止值，并首先进行了分析以确定检测阳性活检的适应症截止值。

方法

2018年该市68,566例前列腺癌筛查数据与癌症登记数据相结合。在确定筛查一年内是否登记癌症后，使用受试者工作特征曲线计算预测不同年龄组前列腺癌的最佳前列腺特异性抗原水平。

结果

在传统前列腺特异性抗原阈值 4.0 ng/mL 下，敏感性、特异性和阴性预测值分别为 94.9%、91.7% 和 91.7%。50-59岁、60-69岁、70-79岁和80岁以上患者的最佳前列腺特异性抗原临界值分别为3.900 ng/mL、4.014 ng/mL、4.080 ng/mL和4.780 ng/mL。分别为毫升。

结论

该市前列腺癌筛查的敏感性和特异性较高，筛查准确率较高。80 岁以上患者的前列腺特异性抗原阈值为 4.78 ng/mL。较高的前列腺特异性抗原阈值可能对 80 岁以上的男性有用，以避免过多的活检并降低成本。我们的结果表明，目前日本使用 PSA 4.0 ng/mL 作为临界值（无论年龄如何）的方法可能并不适合老年男性。