Prostate-specific antigen testing for prostate cancer: Depleting a limited pool of susceptible individuals?
Prostate-specific antigen testing for prostate cancer: Depleting a limited pool of susceptible individuals?
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DOI：
10.1007/s10654-016-0185-z
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发表时间：
2017-06
影响因子：
13.6
通讯作者：
Aalen OO
中科院分区：
文献类型：
--
作者：
Valberg M;Grotmol T;Tretli S;Veierød MB;Moger TA;Devesa SS;Aalen OO
20世纪80年代引入前列腺特异性抗原(PSA)检测后，美国前列腺癌的发病率急剧上升。按年龄划分的发病率模式明显向低龄化转变，老年发病率呈下降趋势。挪威也出现了类似的趋势。我们调查这些特征，结合PSA检测，是否可以用人群中不同程度的前列腺癌易感性来解释。我们分析了1973年至2010年美国监测、流行病学和最终结果计划的发病率数据，其中包括511,027例40岁男性前列腺癌的发病率数据，以及挪威1953年至2011年的全国发病率数据，其中包括113,837例50岁男性前列腺癌≥≥。我们开发了一个脆弱的模型，在这个模型中，只有一部分人可能会患前列腺癌，其中由于大量使用PSA检测而导致的诊断风险增加的模型是通过包含这种风险异质性来建模的。脆弱模型很好地符合观察到的数据，并捕捉了出生队列中年龄特定的发病率模式的变化。美国男性的易感比例为39.9%(95%可信区间38.2；41.6%)，挪威为30.4%(95%可信区间28.9；32.0%)。在接受PSA检测的出生队列中，老年人的累积发病率没有变化。前列腺癌队列特定年龄-发病率曲线的峰值可能由前列腺癌风险的潜在异质性解释。PSA测试的引入导致了更多的被诊断为男性。然而，在越来越年轻的接触PSA时代的出生队列中，总共没有更多的病例被诊断出来，尽管他们是在更年轻的时候被诊断出来的。再加上年轻人群的年龄-发病率曲线较早达到峰值，以及癌症的强烈家族相关性，这构成了令人信服的证据，表明在有限的易感个体池中，PSA检测导致了更高的比例和更早的诊断时间。
After the introduction of the prostate specific antigen (PSA) test in the 1980s, a sharp increase in the incidence rate of prostate cancer was seen in the United States. The age-specific incidence patterns exhibited remarkable shifts to younger ages, and declining rates were observed at old ages. Similar trends were seen in Norway. We investigate whether these features could, in combination with PSA testing, be explained by a varying degree of susceptibility to prostate cancer in the populations. We analyzed incidence data from the United States’ Surveillance, Epidemiology, and End Results program for 1973–2010, comprising 511,027 prostate cancers in men ≥40 years old, and Norwegian national incidence data for 1953–2011, comprising 113,837 prostate cancers in men ≥50 years old. We developed a frailty model where only a proportion of the population could develop prostate cancer, and where the increased risk of diagnosis due to the massive use of PSA testing was modelled by encompassing this heterogeneity in risk. The frailty model fits the observed data well, and captures the changing age-specific incidence patterns across birth cohorts. The susceptible proportion of men is 39.9 % (95 % CI 38.2; 41.6 %) in the United States and 30.4 % (95 % CI 28.9; 32.0 %) in Norway. Cumulative incidence rates at old age are unchanged across birth cohort exposed to PSA testing at younger and younger ages. The peaking cohort-specific age-incidence curves of prostate cancer may be explained by the underlying heterogeneity in prostate cancer risk. The introduction of the PSA test has led to a larger number of diagnosed men. However, no more cases are being diagnosed in total in birth cohorts exposed to the PSA era at younger and younger ages, even though they are diagnosed at younger ages. Together with the earlier peak in the age-incidence curves for younger cohorts, and the strong familial association of the cancer, this constitutes convincing evidence that the PSA test has led to a higher proportion, and an earlier timing, of diagnoses in a limited pool of susceptible individuals.
影响因子：
3.7
作者：
Soto-Ortiz L;Brody JP
通讯作者：
Brody JP