Detection of prostate cancer via biopsy in the medicare-SEER population during the PSA era
Detection of prostate cancer via biopsy in the medicare-SEER population during the PSA era
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DOI：
10.1093/jnci/djm119
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发表时间：
2007-09-19
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影响因子：
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通讯作者：
Barry, Michael J.
中科院分区：
文献类型：
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作者：
Welch, H. Gilbert;Fisher, Elliott S.;Barry, Michael J.
背景：尽管前列腺特异性抗原(PSA)作为前列腺癌的筛查试验受到了相当多的关注，但真正确定前列腺癌诊断的是针刺活检，而不是PSA检测结果。方法我们将医疗保险申报数据与监测、流行病学和最终结果(SEER)数据联系起来，以分析1993年至2001年在居住在SEER地区的8,273名65岁及以上参加联邦医疗保险B部分的男性进行10429次针吸活检后的结果。我们确定了在被诊断为前列腺癌之后进行针吸活检的比例，多次活检后前列腺癌的累积风险，以及在之前的活检中未发现前列腺癌的男性随后进行活检的风险。结果经针吸活检发现前列腺癌的总比例为32%(95%可信区间[CI]=31%~33%)。收益率随年龄增长而增加(65-69岁男性为26%，70-74岁男性为31%，75-79岁男性为35%，80岁及以上男性为41%；P-趋势
Background Despite the considerable attention given to the prostate-specific antigen (PSA) as a screening test for prostate cancer, it is needle biopsy-and not the PSA test result-that actually establishes the diagnosis of prostate cancer. We sought national estimates on the proportion of men found to have prostate cancer after a needle biopsy of the prostate and the risk of subsequent biopsies among those not found to have prostate cancer.Methods We linked Medicare claims data to Surveillance, Epidemiology, and End Results (SEER) data to analyze outcomes after 10429 needle biopsies performed in 1993 through 2001 in 8273 men aged 65 years and older enrolled in Medicare Part B who resided in a SEER area. We determined the proportion of needle biopsies that were followed by a diagnosis of prostate cancer, the cumulative risk of prostate cancer following multiple biopsies, and the risk of subsequent biopsy among men not found to have prostate cancer in the previous biopsy. All statistical tests were two-sided.Results The overall proportion of needle biopsies found to contain prostate cancer was 32% (95% confidence interval [Cl] = 31% to 33%). The yield increased with age (26% for men aged 65-69 years, 31% for men aged 70-74 years, 35% for men aged 75-79 years, and 41% for men aged 80 years and older; P-trend