中年基线前列腺特异性抗原 (MB PSA) 定义为 40-59 岁之间测量的单一 PSA 值，已被提议作为一种可以限制 PSA 筛查潜在危害的工具。本研究旨在考察 MB PSA 与 PSA 倍增时间 (PSADT) 和 PSA 速度 (PSAV) 的比较，以评估不同的当代北美人群患致命性前列腺癌 (PCa) 的可能性。 40-59 岁男性1995 年至 2019 年间接受第一次 PSA 的 old 也被包括在内。对于 MB PSA 值，包含第一个 PSA 测试结果。对于 PSADT，包括前两次 PSA 测试结果。对于PSAV，包括30个月内的前3次PSA测试结果。选择标准导致共有 77,594 名患者具有至少两次 PSA 测试结果，11,634 名患者具有至少三项 PSA 测试结果。使用多变量细灰色回归来检查 PSA 检测方法的值对致命性 PCa 发展（定义为诊断时或随访期间因 PCa 死亡或发生转移性疾病）的影响。绘制了 5 年、10 年和 15 年的时间依赖性受试者工作特征/曲线下面积 (AUC)。在主要队列中，患者最常见于 50-54 岁年龄组 (32.8%)，患有 Charlson 合并症指数为0（70.5％），并且是白人（63.2％）。其中，9.3% 的中年基线 PSA 位于前 10 个百分位数，0.4% 的 PSADT 为 0-6 个月。 593 名 (0.8%) 患者被诊断出致命性 PCa。致死性 PCa 的中位时间（四分位距）为 8.6（3.2-14.9）年。在主要队列中，MB PSA 和 PSADT 与致命性 PCa 的发生显着相关，风险比 (HR) 为 6.10（95% 置信区间 [CI]，4.85-7.68），HR 为 2.20（95% CI， 1.07-4.54）分别适用于前 10 个百分位 MB PSA 组和 PSADT 0 至 <6 个月组的患者。在具有三个可用 PSA 结果的患者中，MB PSA 和 PSAV 显示与致死性 PCa 的发生显着相关，其中患者的 HR 分别为 3.95（95% CI，2.29-6.79）和 3.57（95% CI，2.17-5.86）。分别位于前 10 个百分位数 MB PSA 组和PSAV >0.4 ng/mL/年组中。在评估致死性 PCa 的可能性时，PSADT 和 PSAV 的 AUC 并不高于 MB PSA。具体而言，PSADT 在 10 年和 15 年时分别为 0.818 和 0.708；对于 PSAV，10 年和 15 年分别为 0.862 和 0.756； MB PSA 在 10 岁时和 15 岁时分别为 0.868 和 0.762（均 p > .05）。研究结果表明，在评估发生致命 PCa 的可能性时，PSAV 或 PSADT 并不优于中年基线。这表明这些变量可能无法实际用于增强临床环境中的 PSA 筛查策略。© 2024 美国癌症协会。

Midlife baseline prostate-specific antigen (MB PSA), defined as a single PSA value measured between 40-59 years of age, has been proposed as a tool that can limit potential harms of PSA screening. This study aimed to examine the ability of MB PSA versus PSA doubling time (PSADT) and PSA velocity (PSAV) in assessing the likelihood of developing of lethal prostate cancer (PCa) in a diverse and contemporary North American population.Men 40-59 years old, who received their first PSA between the years 1995 and 2019, were included. For MB PSA values, the first PSA test result was included. For PSADT, the first two PSA test results were included. For PSAV, the first three PSA test results within 30 months were included. Selection criteria resulted in a total of 77,594 patients with at least two PSA test results and 11,634 patients with at least three PSA test results. Multivariable Fine-Gray regression was used to examine the impact of the value of the PSA testing methods on the development of lethal PCa (defined as death from PCa or development of metastatic disease either at diagnosis or during follow-up). Time-dependent receiver operating characteristic/area under the curve (AUC) at 5, 10, and 15 years were plotted.In the main cohort, patients were most frequently in the 50-54 age category (32.8%), had a Charlson comorbidity index of 0 (70.5%), and were White (63.2%). Of these, 9.3% had the midlife baseline PSA in the top 10th percentile, and 0.4% had a PSADT 0-6 months. Lethal PCa was diagnosed in 593 (0.8%) patients. The median (interquartile range) time to lethal PCa was 8.6 (3.2-14.9) years. In the main cohort, MB PSA and PSADT showed significant associations with the occurrence of lethal PCa, with a hazard ratio (HR) of 6.10 (95% confidence interval [CI], 4.85-7.68) and HR of 2.20 (95% CI, 1.07-4.54) for patients in the top 10th percentile MB PSA group and in the PSADT between 0 to <6 months group, respectively. In patients with three PSA results available, MB PSA and PSAV showed significant associations with the occurrence of lethal PCa, with a HR of 3.95 (95% CI, 2.29-6.79) and 3.57 (95% CI, 2.17-5.86) for patients in the top 10th percentile MB PSA group and in the in the PSAV >0.4 ng/mL/year group, respectively. PSADT and PSAV did not exhibit higher AUCs than MB PSA in assessing the likelihood of lethal PCa. Specifically, they were 0.818 and 0.708 at 10 and 15 years, respectively, for the PSADT; 0.862 and 0.756 at 10 and 15 years, respectively, for the PSAV; and 0.868 and 0.762 at 10 and 15 years, respectively, for the MB PSA (all p > .05).The study findings are that PSAV or PSADT were not superior to midlife baseline in assessing the likelihood of developing lethal PCa. This suggests that these variables may not have practical use in enhancing PSA screening strategies in a clinical setting.© 2024 American Cancer Society.