Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians
Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians
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DOI：
10.7326/0003-4819-158-10-201305210-00633
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发表时间：
2013-05-21
影响因子：
39.2
通讯作者：
Shekelle, Paul
中科院分区：
文献类型：
--
作者：
Qaseem, Amir;Barry, Michael J.;Shekelle, Paul
描述：前列腺癌是男性的一个重要健康问题。它很少导致 50 岁以下男性死亡；大多数与此相关的死亡发生在 75 岁以上的男性中。对大多数男性来说，前列腺特异性抗原 (PSA) 测试筛查的好处大于其危害。在通过 PSA 检测检测出的相当大比例的前列腺癌男性中，前列腺癌在患者的一生中从未变得具有临床意义。他们不会从前列腺癌的治疗中获得任何好处，并且会受到严重伤害。美国医师学会 (ACP) 通过评估其他组织制定的当前前列腺癌筛查指南，为临床医生制定了这份指导声明。 ACP 认为，当某个主题有多个指南可用或现有指南发生冲突时，为临床医生提供对现有指南的严格审查比针对同一主题制定新指南更有价值。本指导声明的目的是严格审查现有指南，以帮助指导内科医生和其他临床医生做出有关前列腺癌筛查的决策。本指导声明的目标患者群体是所有成年男性。方法：本指导声明源自对前列腺癌筛查现有指南的评估。作者检索了国家指南信息交换所，以确定美国的前列腺癌筛查指南，并选择了由美国预防医学会、美国癌症协会、美国泌尿外科协会和美国预防服务工作组制定的 4 条指南。 AGREE II（欧洲指南、研究和评估评估）工具用于评估该指南。指南声明 1：ACP 建议临床医生告知 50 至 69 岁之间的男性，前列腺癌筛查的潜在益处有限，但危害较大。 ACP 建议临床医生根据前列腺癌的风险、对筛查的利弊的讨论、患者的总体健康状况和预期寿命以及患者的偏好来决定使用前列腺特异性抗原检测来筛查前列腺癌。 ACP 建议临床医生不应使用前列腺特异性抗原测试对未明确表示愿意进行筛查的患者进行前列腺癌筛查。 指导声明 2：ACP 建议临床医生不应对 50 岁以下的平均风险男性、69 岁以上的男性或预期寿命少于 10 至 15 岁的男性使用前列腺特异性抗原测试来筛查前列腺癌。
Description: Prostate cancer is an important health problem in men. It rarely causes death in men younger than 50 years; most deaths associated with it occur in men older than 75 years. The benefits of screening with the prostate-specific antigen (PSA) test are outweighed by the harms for most men. Prostate cancer never becomes clinically significant in a patient's lifetime in a considerable proportion of men with prostate cancer detected with the PSA test. They will receive no benefit and are subject to substantial harms from the treatment of prostate cancer. The American College of Physicians (ACP) developed this guidance statement for clinicians by assessing current prostate cancer screening guidelines developed by other organizations. ACP believes that it is more valuable to provide clinicians with a rigorous review of available guidelines rather than develop a new guideline on the same topic when several guidelines are available on a topic or when existing guidelines conflict. The purpose of this guidance statement is to critically review available guidelines to help guide internists and other clinicians in making decisions about screening for prostate cancer. The target patient population for this guidance statement is all adult men.Methods: This guidance statement is derived from an appraisal of available guidelines on screening for prostate cancer. Authors searched the National Guideline Clearinghouse to identify prostate cancer screening guidelines in the United States and selected 4 developed by the American College of Preventive Medicine, American Cancer Society, American Urological Association, and U. S. Preventive Services Task Force. The AGREE II (Appraisal of Guidelines, Research and Evaluation in Europe) instrument was used to evaluate the guidelines.Guidance Statement 1: ACP recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer. ACP recommends that clinicians base the decision to screen for prostate cancer using the prostate-specific antigen test on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences. ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in patients who do not express a clear preference for screening.Guidance Statement 2: ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years.