Under diagnosis and over diagnosis of prostate cancer
Under diagnosis and over diagnosis of prostate cancer
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DOI：
10.1016/j.juro.2007.03.017
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发表时间：
2007-07-01
影响因子：
6.6
通讯作者：
Catalona, William J.
中科院分区：
文献类型：
--
作者：
Graif, Theresa;Loeb, Stacy;Catalona, William J.
目的：我们量化了过去15年中2个大型患者队列中前列腺癌的确诊率和确诊率。材料与方法：1989 - 1995年、1995 - 2001年、2001 - 2005年3个时间段中的1个时间段，共2126例临床分期为T1c的前列腺癌患者行根治性前列腺切除术。我们分别检查了符合过度诊断（0.5 cm(3)或以下，局限于前列腺，手术边缘清晰，无Gleason模式4或5）和诊断不足（非器官局限，病理分期T3或以上，或手术边缘阳性）标准的男性肿瘤的比例。结果：男性肿瘤超诊比例为1.3% ~ 7.1%。未被确诊的前列腺癌患者比例为25%至30%。一个辅助发现是，在筛查人群中，前列腺特异性抗原活检阈值从4.0降低到2.5 ng/ml，导致诊断不足率从30%降低到26%，诊断过度率从1.3%提高到7.1%，5年无进展生存率从85%增加到92%。55岁或更年轻的男性更有可能达到我们对癌症过度诊断的标准。结论：前列腺癌的漏诊率高于漏诊率。将推荐活检的前列腺特异性抗原阈值降低至2.5 ng/ml，可降低漏诊率和提高无进展生存率。
Purpose: We quantified the rates of over and under diagnosis of prostate cancer in 2 large patient cohorts during the last 15 years.Materials and Methods: A total of 2,126 men with clinical stage T1c prostate cancer were treated with radical prostatectomy during 1 of the 3 periods 1989 to 1995, 1995 to 2001 and 2001 to 2005. The respective proportions of men with a tumor that met our criteria for over diagnosis (0.5 cm(3) or less, confined to the prostate with clear surgical margins and no Gleason pattern 4 or 5) and under diagnosis (nonorgan confined, pathological stage T3 or greater, or positive surgical margins) were examined.Results: The proportion of men with an over diagnosed tumor was 1.3% to 7.1%. The proportion with prostate cancer that was under diagnosed was 25% to 30%. An ancillary finding was that decreasing the prostate specific antigen threshold for biopsy from 4.0 to 2.5 ng/ml in the screened population resulted in a lower rate of under diagnosis from 30% to 26%, a higher rate of over diagnosis from 1.3% to 7.1% and an increase in the 5-year progression-free survival rate from 85% to 92%. Men who were 55 years or younger were significantly more likely to meet our criteria for over diagnosed cancer.Conclusions: Under diagnosis of prostate cancer continues to occur more frequently than over diagnosis. Lowering the prostate specific antigen threshold for recommending biopsy to 2.5 ng/ml resulted in a lower rate of under diagnosis and a higher progression-free survival rate.