INCIDENCE OF PROSTATE-CANCER DIAGNOSIS IN THE ERAS BEFORE AND AFTER SERUM PROSTATE-SPECIFIC ANTIGEN TESTING
INCIDENCE OF PROSTATE-CANCER DIAGNOSIS IN THE ERAS BEFORE AND AFTER SERUM PROSTATE-SPECIFIC ANTIGEN TESTING
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DOI：
10.1001/jama.274.18.1445
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发表时间：
1995-11-08
影响因子：
120.7
通讯作者：
LIEBER, MM
中科院分区：
文献类型：
--
作者：
JACOBSEN, SJ;KATUSIC, SK;LIEBER, MM
目的：估计1983年至1999年明尼苏达州奥姆斯特德县前列腺癌的发病率，以描述自1987年将血清前列腺特异性抗原(PSA)检测引入社区医疗实践以来所发生的长期变化。设计-基于人群的描述性流行病学研究，并随时间推移进行生态和个人水平的比较。研究背景。-明尼苏达州奥姆斯特县，罗切斯特流行病学项目提供对人群健康结果的被动监测。研究对象-所有511例经活检证实的前列腺癌病例从1983年至1992年诊断。结果：经活检证实的前列腺癌的年龄调整发病率由1983年的每10万人年上升至1992年的每10万人年215人。这种增加主要发生在1987年至1988年之间，主要发生在器官受限的肿瘤上。在同一时期，50岁及以上男性的年龄别发病率大幅上升。然而，在70岁及以上的男性中，前列腺癌发病率在1990年后下降，最初是上升的。老年男性的这一下降与社区对PSA使用率的估计形成对比，社区估计的PSA使用率自1987年以来持续上升，1992年接近50%的老年人口。结论--这些结果支持这样的假设，即最近前列腺癌的增加部分是由于血清PSA检测使用率的增加。此外，增加的发病率似乎是一种暂时现象，因为以前未诊断的病例从流行率池中耗尽。最后，这些数据表明，就诊断阶段而言，早期发现努力可能有效地识别更多早期(较小)癌症。
Objective.-To estimate the incidence of prostate cancer in Olmsted County, Minnesota, from 1983 through 1999 to describe the secular changes that have occurred since the introduction of serum prostate-specific antigen (PSA) testing to the community medical practice in 1987.Design.-Population-based, descriptive epidemiological study with ecologic and individual level comparisons over time.Study Setting.-Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes.Subjects.-All 511 biopsy-proven incident cases of adenocarcinoma of the prostate diagnosed from 1983 through 1992. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of men at the time of diagnosis.Results.-The age-adjusted incidence of biopsy-proven prostate cancer increased from 64 per 100 000 person-years in 1983 to 215 per 100 000 person-years in 1992. The increase occurred primarily between 1987 and 1988 and was predominately for organ-confined tumors. The age-specific incidence increased dramatically in this same period among men aged 50 years and older. Among men aged 70 years and older, however, prostate carcinoma incidence rates declined after 1990 following the initial increase. This decline among older men contrasted with community-based estimates of PSA utilization rates, which demonstrated consistent increases since 1987 to nearly 50% of the older population in 1992.Conclusion.-These results support the premise that the recent increase in prostate cancer is due in part to the increased utilization of serum PSA testing. Further, the increased incidence appears to be a transient phenomenon due to the depletion of previously undiagnosed cases from the prevalence pool. Finally, these data suggest that, in terms of stage at diagnosis, early detection efforts may be effective in identifying more early stage (smaller) cancers.