Five-year downstream outcomes following prostate-specific antigen screening in older men.
Five-year downstream outcomes following prostate-specific antigen screening in older men.
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DOI：
10.1001/jamainternmed.2013.323
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发表时间：
2013-05-27
影响因子：
39
通讯作者：
Hoffman, Richard M.
中科院分区：
文献类型：
--
作者：
Walter, Louise C.;Fung, Kathy Z.;Kirby, Katharine A.;Shi, Ying;Espaldon, Roxanne;O'Brien, Sarah;Freedland, Stephen J.;Powell, Adam A.;Hoffman, Richard M.
尽管围绕PSA筛查的争议不断，但大量65岁以上的男性接受筛查。然而，在临床实践中，很少有数据量化筛选后的事件链，以更好地为决策提供信息。本研究的目的是量化老年男性PSA筛查结果> 4 ng/ml后的5年下游结局。2003年在VA医疗保健系统接受PSA筛查的295，645名65岁以上男性的纵向队列研究，并使用国家VA和Medicare数据进行了5年随访。根据基线特征，在PSA指数筛查> 4 ng/ml的男性中，我们确定了接受活检、诊断为前列腺癌、接受治疗并存活5年的人数。活检和治疗并发症也进行了评估。25，208例（8.5%）男性的PSA指数> 4 ng/ml。在5年随访期间，8，313名（33%）男性至少接受了一次活检，5，220名（63%）活检男性被诊断患有前列腺癌，其中4，284名（82%）接受了治疗。随着年龄的增长和合并症的恶化，活检的接受率下降（P<0.001），而即使在85岁以上的男性中，那些Charlson评分3+的人，以及那些患有低风险癌症的人中，活检检测到癌症的治疗百分比也超过75%。在活检发现癌症的男性中，非前列腺癌原因的死亡风险随着年龄和合并症的增加而增加（P<0.001）。468例（6%）男性发生了7天活检并发症。治疗并发症包括584例（14%）新发尿失禁男性和588例（14%）新发勃起功能障碍男性。PSA筛查异常的老年男性接受活检的比例较低，且随着年龄的增长和合并症的发生而降低。然而，一旦活检检测到癌症，大多数男性立即接受治疗，无论年龄增长，合并症或低风险癌症。了解临床实践中的下游结果应该更好地为考虑PSA筛查的老年男性提供个性化决策。
Despite ongoing controversies surrounding PSA screening, large numbers of men age 65+ undergo screening. However, there are few data quantifying the chain of events following screening in clinical practice to better inform decisions. The objective of this study is to quantify 5-year downstream outcomes following a PSA screening result > 4 ng/ml in older men. Longitudinal cohort study of 295,645 men age 65+ who underwent PSA screening in the VA healthcare system in 2003 and were followed for 5 years using national VA and Medicare data. Among men whose index screening PSA was > 4 ng/ml we determined the number who underwent biopsy, were diagnosed with prostate cancer, were treated and survived 5-years, according to baseline characteristics. Biopsy and treatment complications were also assessed. 25,208 (8.5%) men had an index PSA > 4 ng/ml. During 5-year follow-up, 8,313 (33%) men underwent at least one biopsy, 5,220 (63%) of men biopsied were diagnosed with prostate cancer of whom 4,284 (82%) were treated. Receipt of biopsy decreased with advancing age and worsening comorbidity (P<0.001), whereas the percentage treated for biopsy-detected cancer exceeded 75% even among men age 85+, those with Charlson score 3+, and those with low-risk cancer. Among men with biopsy-detected cancer, the risk of dying of non-prostate cancer causes increased with advancing age and comorbidity (P<0.001). 468 (6%) of men had 7-day biopsy complications. Treatment complications included 584 (14%) men with new incontinence and 588 (14%) men with new erectile dysfunction. Receipt of biopsy is low in older men with abnormal screening PSA and decreases with advancing age and comorbidity. However, once biopsy detects cancer most men undergo immediate treatment regardless of advancing age, comorbidity, or low-risk cancer. Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
6.2
作者：
Daskivich, Timothy J.;Chamie, Karim;Litwin, Mark S.
通讯作者：
Litwin, Mark S.
影响因子：
39.2
作者：
Keating, Nancy L.;Landrum, Mary Beth;McNeil, Barbara J.
通讯作者：
McNeil, Barbara J.
影响因子：
3
作者：
Hynes, Denise M.;Koelling, Kristin;Kok, Linda
通讯作者：
Kok, Linda
DOI：
10.1093/gerona/gls135
发表时间：
2013-01-01
影响因子：
5.1
作者：
Howrey, Bret T.;Kuo, Yong-Fang;Goodwin, James S.
通讯作者：
Goodwin, James S.