初诊未治 PSA≥20ng/mL 高度可疑前列腺癌患者临床特征的 10 年真实世界数据分析

Ten-year real-world data analysis of clinical characteristics in treatment-naive patients with highly suspected prostate cancer and PSA level ≥20ng/mL

摘要

目的 分析初诊未治前列腺特异性抗原（PSA）≥20 ng/mL 高度可疑前列腺癌（PCa）患者的临床病理特征，以期为推进 PCa 的早期筛查工作提供参考。方法 回顾性分析 2013 年 1 月-2023 年 6 月于天津医科大学第二医院泌尿外科就诊的初诊未治 PSA≥20 ng/mL 高度可疑 PCa 而进行前列腺穿刺活检患者的临床资料。评估患者的年龄、身体质量指数（BMI）、PSA 水平、前列腺体积（PV）、前列腺特异性抗原密度（PSAD）、前列腺影像报告和数据系统（PI-RADS）、国际泌尿学会评分（ISUP）等指标与高度可疑 PCa 转移情况和 PSA 分层的相关性。结果 本研究共纳入 1778 例 PSA≥20ng/mL 高度可疑 PCa 患者进行前列腺穿刺活检。病理结果证实 1465 例（82.4%）患者为 PCa，其中 487 例（33.2%，487/1465）患者为转移性 PCa。近 10 年，因 PSA≥ 20 ng/mL的高度可疑 PCa 而进行前列腺穿刺活检的患者数量和确诊 PCa 患者数量逐年增加，而转移性 PCa 患者占比持续维持在 30%。相比于 PSA20～50 ng/mL 组，PSA＞50 ng/mL 组的患者年龄更大、BMI 更低、城市人口的占比更低、PSAD 更高、PI-RADS 评分及 ISUP 分组更高、特殊病理类型更多以及转移比例更高，差异均有统计学意义（P＜0.05）。转移性 PCa 中有 46.8% （228/487）寡转移（转移灶≤5 处），其中 99.0%骨转移、4.1%区域外淋巴结转移、4.3%其他器官转移。结论 近 10 年，初诊未治 PSA≥20 ng/mL 高度可疑 PCa 患者的穿刺活检人数和新确诊 PCa 患者人数逐年增加，但是转移性 PCa 患者占比依然较高。因此，应积极推动高危可疑 PCa 患者的早期筛查工作。

Abstract

Objective To analyze the clinicopathological characteristics of treatment-naive patients with highly suspected prostate cancer (PCa) with prostate-specific antigen (PSA) level ≥ 20 ng/mL, to provide reference for promoting early screening of PCa. Methods A retrospective analysis was conducted on the clinical data of treatment-naive patients with PSA level ≥ 20 ng/mL, undergoing prostate biopsy for highly suspected PCa at the Department of Urology, Tianjin Medical University Second Hospital during Jan. 2013 and Jun. 2023. The correlation between patients' age, body mass index (BMI), PSA, prostate volume (PV), prostate cancer-specific antigen density (PSAD), prostate imaging reporting and data system (PI-RADS) score, and International Society of Urological Pathology (ISUP) grade with highly suspected PCa metastasis and PSA stratification were analyzed. Results A total of 1778 suspected patients were enrolled. Pathological findings confirmed PCa in 1465 cases (82.4%), with 487 (33.2%) diagnosed as metastatic PCa. Over the past decade, the number of patients undergoing prostate biopsy for highly suspected PCa and being confirmed has been increasing annually, with the proportion of metastatic cases remaining at around 30%. Compared with those with PSA level being 20-50 ng/mL, patients with PSA level ＞50 ng/mL had older age, lower BMI, higher PSAD, higher PI-RADS, higher ISUP, more diverse pathological types, and a higher incidence of metastasis (P＜0.05) with lower proportion of urban residents. Additionally, analysis of metastatic PCa cases showed that 46.8% (228/487) had oligometastasis (≤5 metastatic lesions), including 99.0% bone metastasis, 4.1% extraregional lymph node metastasis, and 4.3% other organ metastasis. Conclusion Over the past 10 years, there has been a continuous increase in the number of treatment-naive biopsied cases and newly diagnosed cases of highly suspicious PCa with PSA level ≥20 ng/mL, while the proportion of metastatic cases remains high. Therefore, proactive efforts should be made to promote early screening of high-risk suspected cases.

关键词

前列腺癌 / 前列腺特异性抗原 / 局限性前列腺癌 / 转移性前列腺癌 / 早期筛查

Key words

prostate cancer / prostate-specific antigen / localized prostate cancer / metastatic prostate cancer / early screening

参考文献

[1] BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.

[2] WANG L, LU B, HE M, et al. Prostate cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019[J]. Front Public Health, 2022, 10: 811044.

[3] HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.

[4] ZHU Y, MO M, WEI Y, et al. Epidemiology and genomics of prostate cancer in Asian men[J]. Nat Rev Urol, 2021, 18(5): 282-301.

[5] WANG F, WANG C, XIA H, et al. Burden of prostate cancer in china, 1990-2019: findings from the 2019 global burden of disease study[J]. Front Endocrinol (Lausanne), 2022, 13: 853623.

[6] HEALTH COMMISSION OF THE PEOPLE'S REPUBLIC OF CHINA. National guidelines for diagnosis and treatment of prostate cancer 2022 in China (English version)[J]. Chin J Cancer Res, 2022, 34(3): 270-288.

[7] LIU J, DONG L, ZHU Y, et al. Prostate cancer treatment-China's perspective[J]. Cancer Lett, 2022, 550: 215927.

[8] VAN POPPEL H, ALBREHT T, BASU P, et al. Serum PSA-based early detection of prostate cancer in Europe and globally: past, present and future[J]. Nat Rev Urol, 2022, 19(9): 562-572.

[9] CHOW KM, SO WZ, LEE HJ, et al. Head-to-head comparison of the diagnostic accuracy of prostate-specific membrane antigen positron emission tomography and conventional imaging modalities for initial staging of intermediate- to high-risk prostate cancer: a systematic review and meta-analysis[J]. Eur Urol, 2023, 84(1): 36-48.

[10] HUANG J, CHAN EO, LIU X, et al. Global trends of prostate cancer by age, and their associations with gross domestic product (GDP), human development index (HDI), smoking, and alcohol drinking[J]. Clin Genitourin Cancer, 2023, 21(4): e261-e270.e50.

[11] SOERJOMATARAM I, CABASAG C, BARDOT A, et al. Cancer survival in Africa, central and south America, and Asia (SURVCAN-3): a population-based benchmarking study in 32 countries[J]. Lancet Oncol, 2023, 24(1): 22-32.

[12] JIANG X, CHEN M, TIAN J, et al. Comparison of regional saturation biopsy, targeted biopsy, and systematic biopsy in patients with prostate-specific antigen levels of 4-20 ng/mL: a prospective, single-center, randomized controlled trial[J]. Eur Urol Oncol, 2024, 7(4): 944-953.

[13] CHEN Y, JIANG X, LIU R, et al. The specific choice of transrectal ultrasound-guided prostate biopsy scheme based on prostate specific antigen and prostate specific antigen density[J]. Med Sci Monit, 2019, 25: 6230-6235.

[14] 中国抗癌协会泌尿男生殖系统肿瘤专业委员会前列腺癌学组. 前列腺癌筛查中国专家共识（2021 年版）[J]. 中国癌症杂志, 2021, 31(5): 435-440.

[15] DU XL, GAO D, LI Z. Incidence trends in prostate cancer among men in the United States from 2000 to 2020 by race and ethnicity, age and tumor stage[J]. Front Oncol, 2023, 13: 1292577.

[16] 王少明, 郑荣寿, 韩冰峰, 等. 2022 年中国人群恶性肿瘤发病与死亡年龄特征分析[J]. 中国肿瘤, 2024, 33(3): 165-174.

[17] 赫捷, 陈万青, 李霓, 等. 中国前列腺癌筛查与早诊早治指南（2022，北京）[J]. 中国肿瘤, 2022, 31(1): 1-30.

[18] 牛向南, 张雁钢. 晚期前列腺癌内分泌治疗的研究进展[J]. 现代肿瘤医学, 2024, 32(5): 973-977.

[19] TILKI D, VAN DEN BERGH RCN, BRIERS E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. Part II-2024 update: treatment of relapsing and metastatic prostate cancer[J]. Eur Urol, 2024, 86(2): 164-182.

[20] BERGENGREN O, PEKALA KR, MATSOUKAS K, et al. 2022 update on prostate cancer epidemiology and risk factors-a systematic review[J]. Eur Urol. 2023, 84(2): 191-206.

基金资助

国家自然科学基金项目(No.82174174)

天津市卫生健康委项目(No.KJ20169)

天津医科大学第二医院科技项目(No.MNRC202312)

天津医科大学第二医院科技项目(No.MYSRC202306)