The case for prostate cancer screening with prostate-specific antigen
The case for prostate cancer screening with prostate-specific antigen
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DOI：
10.1016/j.eursup.2006.06.013
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发表时间：
2006-08-01
影响因子：
--
通讯作者：
Schroder, Fritz
中科院分区：
文献类型：
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作者：
Andriole, Gerald;Djavan, Bob;Schroder, Fritz
从早期用作前列腺癌进展的标志物开始，前列腺特异性抗原（PSA）已经成熟为数百万男性使用的筛查测试，以帮助前列腺癌检测。尽管其敏感性/特异性特征受到批评，但PSA仍然是前列腺癌最容易获得和最佳的生物标志物。新的证据还表明，它是一种更好的侵袭性疾病的标志物，有助于检测最迫切需要干预的癌症。虽然我们在等待大规模随机研究的结果来确定PSA筛查对前列腺癌死亡率的长期影响，但仍有大量非随机数据证据表明PSA检测对前列腺癌的早期转移有积极影响。不太清楚的是，应如何实施基于PSA的筛查方案，以及其成本效益状况在一些或所有国家是否可以接受。尽管主张将PSA阈值从4.0或3.0 ng/ml降低，但高假阴性率在人群水平上具有真实的意义。此外，早期前列腺癌的干预增加的负担，其总体死亡率低，代表了个人和社会的一个重要问题。很明显，我们需要采取更灵活的阈值方法，考虑到筛查开始的年龄，并使用不同的阈值和筛查间隔，以确保第一，诊断的滞后时间最小化，第二，“过度测试”最小化。(c)2006年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
From its early use as a marker of prostate cancer progression, prostate-specific antigen (PSA) has matured into a screening test used by many millions of men to aid prostate cancer detection. Despite criticism over its sensitivity/specificity profile, PSA remains the most readily available and most optimal biomarker for prostate cancer. New evidence also suggests that it is a better marker of more aggressive disease, aiding detection of cancers that most urgently require intervention. While we await the outcomes of large-scale, randomised studies to determine the long-term impact of PSA screening on prostate cancer mortality, there is still substantive evidence from nonrandomised data that PSA testing has a positive impact in shifting the presentation of prostate cancer to earlier stages. What is less clear is how a PSA-based screening programme should be implemented and whether the cost-benefit profile is acceptable in some or all countries. Although lowering of the PSA threshold from 4.0 or 3.0 ng/ml has been advocated, the high false-negative rate has real implications at a population level. Furthermore, the burden of increased intervention for early prostate cancer, with its low overall mortality, represents a significant issue for individual men and society alike. It is becoming evident that we need to take a more flexible approach to threshold values, taking into account the age at which screening starts, and using different thresholds and screening intervals to ensure that, first, the lag time to diagnosis is minimised and, second, that "over-testing" is minimised. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.