Landmarks in prostate cancer screening
Landmarks in prostate cancer screening
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DOI：
10.1111/j.1464-410x.2012.011428.x
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发表时间：
2012-10-01
影响因子：
4.5
通讯作者：
Schroder, Fritz H.
中科院分区：
文献类型：
--
作者：
Schroder, Fritz H.
前列腺特异性抗原（PSA）在前列腺癌的诊断和随访中得到了广泛的应用，人们对其在前列腺癌早期发现和筛查中的潜在作用进行了研究。PSA筛查在降低疾病死亡率方面的价值是有争议的，已经进行了几项研究来确定其实际益处。早期研究之一，1993年进行的蒂罗尔筛查研究表明，2004年至2008年期间，与1989年至1993年期间的死亡率相比，60岁至60岁男性的前列腺癌死亡率显著降低。1987年和1988年在瑞典进行的两项研究表明，在前列腺癌死亡方面，筛查没有任何好处。1993年至2001年在美国进行的前列腺、肺、结直肠和卵巢筛查研究，涉及76693名男性，在10年内没有发现筛查的好处，但由于未筛查组的过度污染，该试验可以受到批评。相比之下，欧洲前列腺癌筛查随机研究（ERSPC）是最大的随机研究，有163288名参与者参与，结果显示，在中位9年的随访中，前列腺癌死亡率降低了20% （P = 0.04）。在一项限于四个ERSPC中心的分析中，随访12.0年，筛查导致转移性疾病总体减少31%。反对PSA筛查的论据包括与筛查试验本身相关的风险，例如活检相关的血尿、尿毒症以及前列腺癌的过度诊断和过度治疗。总体证据表明，PSA筛查是有利的，可以采取措施，通过主动监测患者来避免过度治疗。
Prostate-specific antigen (PSA) has been widely applied to diagnosis and follow-up of prostate cancer, which led to research on its potential role in the early detection of the disease and its use in screening.The value of PSA screening in reducing disease mortality is controversial and several studies have been conducted to determine the actual benefits. One of the early studies, the Tyrol Screening Study conducted in 1993, showed that during 2004 to 2008 there was a significant reduction in prostate cancer mortality in men aged >60 years compared with the mortality rate during 1989 to 1993.Two studies that showed no benefit of screening in terms of prostate cancer death were conducted in Sweden in 1987 and 1988.The Prostate, Lung, Colorectal, and Ovarian Screening Study conducted in the USA during 1993 to 2001 and involving 76 693 men showed no benefit of screening at 10 years but the trial can be criticised due to excessive contamination of the unscreened group.In contrast, the European Randomized Study of Screening for Prostate Cancer (ERSPC), the largest randomised study with 162 388 participants study, showed that at a median follow-up of 9 years a prostate cancer mortality reduction of 20% resulted (P = 0.04). In an analysis limited to four ERSPC centres with a follow-up of 12.0 years, screening resulted in an overall reduction of metastatic disease of 31%.The arguments against PSA screening include the risks associated with screening tests themselves, e. g. biopsy-related haematuria, urosepsis, and over diagnosis and overtreatment of prostate cancer. The overall evidence points in favour of PSA screening and steps can be taken to avoid overtreatment by offering patients active surveillance.