Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality
Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality
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DOI：
10.1016/j.urology.2006.02.030
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发表时间：
2006-08-01
期刊：
影响因子：
2.1
通讯作者：
D'Amico, Anthony V.
中科院分区：
文献类型：
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作者：
Efstathiou, Jason A.;Chen, Ming-Hui;D'Amico, Anthony V.
目标.比较在筛查研究中诊断为PSA失败的男性与社区转诊人群的术前特征、术后前列腺特异性抗原（PSA）倍增时间（DT）和前列腺癌特异性死亡率（PCSM）估计值。小于3个月的PSA-DT是PCSM的替代终点。从1988年到2002年，9637例临床局限性前列腺癌患者中有1492例接受了根治性前列腺切除术，并经历了PSA失败。他们要么参加了一项筛选研究（n = 841），要么参加了44个以社区为基础的做法之一（n = 611）。使用卡方度量比较PSA、Gleason评分、肿瘤分期和PSA-DT的分布。使用Gray的P值比较PSA失败后PCSM的估计值。与社区人群相比，每年筛查一次的PSA失败男性在诊断时的PSA水平较低（5.1对9.5 ng/mL，P < 0.0001），不太可能患有Gleason评分7至10的癌症（25.1%对42.1%，P < 0.0001），更可能患有低风险疾病（64.5%对23.8%，P < 0.0001）。此外，筛查队列中PSA-DT小于3、3至5.99和6至11.99个月的比例降低（P < 0.0001），PSA-DT为12个月或更长时间的比例显著增加。在筛选队列和社区队列中PSA失败后分别进行了4.5年和4.1年的中位随访后，筛选队列的PCSM估计值较低（P = 0.0002）（10年估计值3.6% [95%置信区间1.3至5.8] vs 11.3% [95%置信区间5.9至17.4]）。与社区转诊的患者相比，通过年度前列腺癌筛查诊断的患者更有可能经历无痛PSA复发，并且在PSA复发后死于前列腺癌的可能性更小。
Objectives. To compare the preoperative characteristics, postoperative prostate-specific antigen (PSA) doubling time (DT), and prostate cancer-specific mortality (PCSM) estimates after PSA failure in men diagnosed during a screening study versus a community referral population. A PSA-DT of less than 3 months is a surrogate endpoint for PCSM.Methods. From 1988 to 2002, 1492 of 9637 patients with clinically localized prostate cancer underwent radical prostatectomy and experienced PSA failure. They were either participating in a screening study (n = 841) or attended 1 of 44 community-based practices (n = 611). The distributions of PSA, Gleason score, tumor stage, and PSA-DT were compared using chi-square metric. The estimates of PCSM after PSA failure were compared using Gray's P value.Results. Compared with the community population, the annually screened men experiencing PSA failure had a lower PSA level at diagnosis (5.1 versus 9.5 ng/mL, P < 0.0001), were less likely to have Gleason score 7 to 10 cancer (25.1 % versus 42.1 %, P < 0.0001), and were more likely to have low-risk disease (64.5% versus 23.8%, P < 0.0001). Furthermore, the screened cohort had a reduction (P < 0.0001) in the proportion with a PSA-DT of less than 3, 3 to 5.99, and 6 to 11.99 months and a significant increase in the proportion with a PSA-DT of 12 months or longer. After a median follow-up of 4.5 and 4.1 years after PSA failure in the screened and community cohorts, respectively, the PCSM estimates were lower (P = 0.0002) in the screened cohort (10-year estimate 3.6% [95% confidence interval 1.3 to 5.8] versus 11.3% [95% confidence interval 5.9 to 17.4]).Conclusions. Patients diagnosed by annual prostate cancer screening appeared more likely to experience an indolent PSA recurrence and less likely to die of prostate cancer after PSA recurrence compared with patients referred from the community.