Family history and prostate cancer screening with prostate-specific antigen
Family history and prostate cancer screening with prostate-specific antigen
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DOI：
10.1200/jco.2002.05.006
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发表时间：
2002-06-01
影响因子：
45.3
通讯作者：
Auvinen, A
中科院分区：
文献类型：
--
作者：
Mäkinen, T;Tammela, TLJ;Auvinen, A
目的：尽管缺乏降低死亡率的证据，但建议有一级亲属受影响的男性早期发现前列腺癌。因此，我们评估了家族史的影响，在芬兰前列腺癌筛查trial.Patients和方法：大约80,000名男性被确定为第一轮筛选的人口登记。在随机分配到筛查组的32，000名男性中，有30，403人在邀请时符合条件。从参与者（n = 20，716）中抽取血液样本，并测定血清前列腺特异性抗原（PSA）。PSA水平大于或等于4.0 ng/mL的男性被转诊进行前列腺活检。家族史的信息是通过自填问卷在baseline.Results：964（5%）的20,716筛选参与者有阳性家族史，105（11%）是筛选阳性。诊断出29个肿瘤，相应的检出率为3.0%（29/964），阳性预测值为28%（29/105）。在19，347名无家族史的男性中，1，487名（8%）PSA水平大于或等于4.0 ng/mL。检出率为2.4%（462/19347），阳性预测值为31%（462/1487）。与阳性家族史相关的风险并未显著增加（率比，1.3; 95%置信区间，0.9 - 1.8）。结果不受检者年龄或受影响亲属诊断时年龄的影响。该计划的敏感性为6%（491例中的29例）（即，选择性筛查政策将错过人群中94%的癌症）。没有差异被认为是在屏幕上检测到的癌症家族history.Conclusion的特点：我们的研究结果提供了没有支持的男性受影响的亲属之间的选择性筛查。(C)2002年，美国临床肿瘤学会。
Purpose: Early detection of prostate cancer has been recommended for men with affected first-degree relatives despite the lack of evidence for mortality reduction. We therefore evaluated the impact of family history in the Finnish prostate cancer screening trial.Patients and Methods: Approximately 80,000 men were identified from the population register for the first screening round. Of the 32,000 men randomized to the screening arm, 30,403 were eligible at the time of invitation. A blood sample was drawn from the participants (n = 20,716), and serum prostate-specific antigen (PSA) was determined. Men with a PSA level greater than or equal to 4.0 ng/mL were referred for prostate biopsy. Information on family history was obtained through a self-administered questionnaire at baseline.Results: A total of 964 (5%) of the 20,716 screening participants had a positive family history, and 105 (11%) were screening-positive. Twenty-nine tumors were diagnosed, corresponding to a detection rate of 3.0% (29 of 964) and a positive predictive value of 28% (29 of 105). Of the 19,347 men without a family history, 1,487 (8%) had a PSA level greater than or equal to 4.0 ng/mL. The detection rate was 2.4% (462 of 19,347) and the positive predictive value was 31% (462 of 1,487). The risk associated with a positive family history was not substantially increased (rate ratio, 1.3; 95% confidence interval, 0.9 to 1.8). The results were not affected by the age of the screenee or age at diagnosis of the affected relative. The program sensitivity was 6% (29 of 491) (ie, selective screening policy would have missed 94% of cancers in the population). No differences were seen in the characteristics of screen-detected cancers by family history.Conclusion: Our findings provide no support for selective screening among men with affected relatives. (C) 2002 by American Society of Clinical Oncology.