Unanswered questions in screening for prostate cancer
Unanswered questions in screening for prostate cancer
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DOI：
10.1016/s0959-8049(00)00104-0
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发表时间：
2000-06-01
影响因子：
8.4
通讯作者：
Donovan, JL
中科院分区：
文献类型：
--
作者：
Neal, DE;Leung, HY;Donovan, JL
前列腺癌满足了疾病所需的一些条件，而这种疾病可能是通过人口筛查来管理的。在一组50到60岁的男性中，进行直肠检查和前列腺特异性抗原(PSA)测试将发现大约5%的临床可疑前列腺区域。大约10%的人将提高PSA。然而，我们不确定在大约30%-40%的60岁以上男性中已知的前列腺癌将被检测到。最终在这样的筛选之后。在前列腺正常的男性中，大约4%的人会被发现患有前列腺癌。使用直肠检查可能会增加发现谣言的数量。但会降低合规性。使用游离/总PSA比率将减少不必要的活检数量，但代价是错过一些肿瘤。更令人担忧的是，我们仍然不确定侵袭性局部治疗在改变疾病自然病史方面的有效性。一家拥有50年历史、预期寿命为25年的购物中心罹患微小癌症的风险为42%，患有临床明显癌症的风险为9.5%，死于前列腺癌的风险为2.9%。在已知的癌症中，只有一小部分在临床上是明显的：死于前列腺癌的男性比死于前列腺癌的男性多。筛查将确定一些患有癌症的男性，他们将无法从治疗中受益。目前尚不清楚筛查之后是否会降低发病率和死亡率。最近的数据表明，在美国已经观察到了筛查效应：发病率增加，远处转移的男性减少。最近观察到的死亡率的小幅下降(比发病率的增加小了许多倍)可能是由于对死因的不适当的“归因”、发现对激素消融有更好预后的男性远处转移疾病以及饮食等社会因素的变化而造成的。未来的变化可能包括分子标记，这些标记可能有助于识别因进展风险而最好进行积极治疗的男性。识别遗传倾向的测试也可能允许进行有针对性的筛查。新的治疗方法和早期的化学预防或饮食策略将再次改变正在排练的这些论点的基础。最迫切需要的证据涉及治疗策略的有效性。(C)2000爱思唯尔科学有限公司。保留所有权利。
Prostate cancer fulfils some of the conditions required of a disease that might be managed by population screening. In a cohort of 50- to 60-year-old men, carrying out a rectal examination and prostate specific antigen (PSA) test will detect clinically suspicious areas within the prostate in approximately 5%. and approximately 10% will have a raised PSA. We are however unsure which of the prostate cancers that an known to be present in approximately 30-40% of men aged over 60 years will be detected. Eventually after such screening. around 4% of men with an otherwise normal prostate will be found to have prostate cancers. The use of rectal examination may increase the number of rumours found. but will reduce compliance. The use of free/total PSA ratios will reduce the number of unnecessary biopsies at the expense of missing some tumours. Of more concern, we remain uncertain how effective aggressive local treatment is in altering the natural history of the disease. The risk of a 50-year-old mall with a 25 year life expectancy of having microscopic cancer is 42%, of having clinically evident cancer is 9.5%, and of dying of prostate: cancer 2.9%. Only a small proportion of cancers known to be present become clinically evident: more men die with prostate cancer than of it. Screening will identify some men with cancer who will not benefit from treatment. It is unclear whether screening would be followed by a reduction in morbidity and mortality. Recent data suggest a screening effect has been observed in the USA with: an increase in incidence, a decrease in men with distant metastases. The small decrease in mortality recently observed (many times smaller than the increase in incidence) may be confounded by inappropriate 'attribution' of cause of death, the detection of men with better prognosis distant metastatic disease responsive to hormonal ablation and changes in social factors such as diet. Future changes may incorporate molecular markers that might aid identification of men best treated aggressively because of a risk of progression. Tests to identify genetic pre-disposition may also allow targeted screening. New treatments and early chemoprevention or dietary strategies will again shift the ground on which these arguments are being rehearsed. The most urgent evidence required concerns the effectiveness of treatment strategies. (C) 2000 Elsevier Science Ltd. All rights reserved.