Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms.
Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms.
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DOI：
10.7326/0003-4819-158-3-201302050-00003
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发表时间：
2013-02-05
影响因子：
39.2
通讯作者：
Etzioni R
中科院分区：
文献类型：
--
作者：
Gulati R;Gore JL;Etzioni R
美国预防服务工作组最近得出的结论是，现有前列腺特异性抗原（PSA）筛查策略的弊大于利。评估替代 PSA 筛查策略的比较有效性。前列腺癌发病率和死亡率的微观模拟模型，量化替代 PSA 筛查策略的危害和挽救的生命。有关 PSA 增长、筛查和活检模式、发病率、治疗分布、治疗效果和死亡率的国家和试验数据。当代美国男性群体。寿命。社会的。 35 种筛查策略因开始/停止年龄、筛查间间隔和活检转诊阈值而异。 PSA 检测、假阳性检测、检测到的癌症、过度诊断、前列腺癌死亡、挽救的生命以及挽救的生命数月。如果不进行筛查，前列腺癌死亡的风险为 2.86%。每年筛查 50-74 岁男性的参考策略，活检转诊的 PSA 阈值为 4 μg/L，可将前列腺癌死亡风险降低至 2.15%，过度诊断风险降低至 3.3%。采用较高 PSA 阈值进行老年男性活检转诊的策略可实现类似的前列腺癌死亡风险 (2.23%)，但将过度诊断的风险降低至 2.3%。对 PSA 水平较低的男性每两年进行一次筛查，筛查间隔较长，其前列腺癌死亡 (2.27%) 和过度诊断 (2.4%) 的风险相似，但总检测量减少了 59%，假阳性检测量减少了 50%。改变发病率输入或减少由于筛查而导致的生存率改善并没有改变结论。该模型是前列腺癌自然史的简化，并且由于筛查而带来的生存改善是不确定的。与标准筛查相比，PSA 筛查策略采用较高的阈值对老年男性进行活检转诊，并且较少筛查 PSA 水平较低的男性，可以减少伤害，同时保留挽救的生命。国家癌症研究所。
The US Preventive Services Task Force recently concluded that the harms of existing prostate-specific antigen (PSA) screening strategies outweigh benefits. To evaluate comparative effectiveness of alternative PSA screening strategies. Microsimulation model of prostate cancer incidence and mortality quantifying harms and lives saved for alternative PSA screening strategies. National and trial data on PSA growth, screening and biopsy patterns, incidence, treatment distributions, treatment efficacy, and mortality. A contemporary cohort of US men. Lifetime. Societal. 35 screening strategies that vary by start/stop ages, inter-screening intervals, and thresholds for biopsy referral. PSA tests, false positive tests, cancers detected, overdiagnoses, prostate cancer deaths, lives saved, and months of life saved. Without screening, the risk of prostate cancer death is 2.86%. A reference strategy that screens men aged 50–74 annually with a PSA threshold for biopsy referral of 4 μg/L reduces the risk of prostate cancer death to 2.15% with risk of overdiagnosis of 3.3%. A strategy that uses higher PSA thresholds for biopsy referral in older men achieves a similar risk of prostate cancer death (2.23%) but reduces the risk of overdiagnosis to 2.3%. A strategy that screens biennially with longer inter-screen intervals for men with low PSA levels achieves similar risks of prostate cancer death (2.27%) and overdiagnosis (2.4%) but reduces total tests by 59% and false positive tests by 50%. Varying incidence inputs or reducing the survival improvement due to screening did not change conclusions. The model is a simplification of prostate cancer natural history, and the survival improvement due to screening is uncertain. PSA screening strategies that use higher thresholds for biopsy referral for older men and that screen men with low PSA levels less frequently can reduce harms while preserving lives saved compared to standard screening. National Cancer Institute.
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影响因子：
6.6
作者：
Etzioni, R;Cha, R;Cowen, ME
通讯作者：
Cowen, ME
影响因子：
45.3
作者：
Crawford, E. David;Grubb, Robert, III;D'Amico, Anthony V.
通讯作者：
D'Amico, Anthony V.
DOI：
10.1056/nejmoa1201637
发表时间：
2012-08-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
Heijnsdijk EA;Wever EM;Auvinen A;Hugosson J;Ciatto S;Nelen V;Kwiatkowski M;Villers A;Páez A;Moss SM;Zappa M;Tammela TL;Mäkinen T;Carlsson S;Korfage IJ;Essink-Bot ML;Otto SJ;Draisma G;Bangma CH;Roobol MJ;Schröder FH;de Koning HJ
通讯作者：
de Koning HJ
影响因子：
6.2
作者：
Cooperberg, Matthew R.;Vickers, Andrew J.;Broering, Jeanette M.;Carroll, Peter R.
通讯作者：
Carroll, Peter R.
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.