Mean sojourn time, overdiagnosis, and reduction in advanced stage prostate cancer due to screening with PSA: implications of sojourn time on screening
Mean sojourn time, overdiagnosis, and reduction in advanced stage prostate cancer due to screening with PSA: implications of sojourn time on screening
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DOI：
10.1038/sj.bjc.6604973
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发表时间：
2009-03-31
影响因子：
8.8
通讯作者：
Neal, D. E.
中科院分区：
文献类型：
--
作者：
Pashayan, N.;Duffy, S. W.;Neal, D. E.
本研究旨在评估前列腺癌的平均停留时间 (MST)，估计过度诊断的可能性，并预测由于 PSA 筛查而可能减少晚期疾病。前列腺癌的 MST 源自 ProtecT 研究的一部分，对 43 842 名年龄在 50-69 岁的男性进行 PSA 患病率检测的检出率、从英国基于人群的癌症登记数据库中获得的非筛查检测病例的发生率，以及从医学文献中获得的 PSA 敏感性。晚期疾病的相对减少源自预期和观察到的晚期前列腺癌的发病率。 50-59 岁和 60-69 岁男性的年龄别 MST 分别为 11.3 和 12.6 岁。过度诊断的估计随着年龄的增长而增加；据估计，PSA 检测到的病例中有 10-31% 被过度诊断。预计 2 年的间隔筛查将使 65-69 岁和 50-54 岁男性的晚期疾病分别减少 37% 和 63%。如果排除过度诊断病例，预计减少率分别为 9% 和 54%。因此，筛查在减少晚期疾病方面的益处受到过度诊断的限制，而过度诊断在老年男性中更为严重。
This study aimed to assess the mean sojourn time (MST) of prostate cancer, to estimate the probability of overdiagnosis, and to predict the potential reduction in advanced stage disease due to screening with PSA. The MST of prostate cancer was derived from detection rates at PSA prevalence testing in 43 842 men, aged 50-69 years, as part of the ProtecT study, from the incidence of non-screen-detected cases obtained from the English population-based cancer registry database, and from PSA sensitivity obtained from the medical literature. The relative reduction in advanced stage disease was derived from the expected and observed incidences of advanced stage prostate cancer. The age-specific MST for men aged 50-59 and 60-69 years were 11.3 and 12.6 years, respectively. Overdiagnosis estimates increased with age; 10-31% of the PSA-detected cases were estimated to be overdiagnosed. An interscreening interval of 2 years was predicted to result in 37 and 63% reduction in advanced stage disease in men 65-69 and 50-54 years, respectively. If the overdiagnosed cases were excluded, the estimated reductions were 9 and 54%, respectively. Thus, the benefit of screening in reducing advanced stage disease is limited by overdiagnosis, which is greater in older men.