The Impact of PSA Screening on Prostate Cancer Mortality and Overdiagnosis of Prostate Cancer in the United States
The Impact of PSA Screening on Prostate Cancer Mortality and Overdiagnosis of Prostate Cancer in the United States
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DOI：
10.1093/gerona/gls135
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发表时间：
2013-01-01
影响因子：
5.1
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
--
作者：
Howrey, Bret T.;Kuo, Yong-Fang;Goodwin, James S.
背景。该研究通过比较美国各县的前列腺特异性抗原（PSA）检测率与前列腺活组织检查率、新治疗的前列腺癌率以及前列腺癌死亡率，评估了前列腺特异性抗原（PSA）检测在美国的影响。我们研究了1997年在美国每个县接受PSA检测的具有全国代表性的5%医疗保险样本中66-74岁男性的百分比，1997年接受前列腺活检或新诊断前列腺癌治疗的男性的百分比，以及1998年至2007年前列腺癌和所有其他原因导致的死亡率之间的关系。对美国1067个县的分析显示，PSA检测率与接受前列腺癌治疗的男性比例和前列腺癌死亡率之间存在显著关系（p < 0.001），但与其他原因导致的死亡率无关。1997年，每10万名接受PSA检测的男性中，有4894名男性接受了前列腺活检，1597名男性接受了前列腺癌治疗，1998年至2006年期间，死于前列腺癌的男性减少了61人。按年龄和种族分层的分析得出了类似的结果。PSA检测与前列腺癌死亡率的适度降低以及过度诊断和过度治疗前列腺癌的男性人数的大幅增加有关。结果与欧洲PSA检测的大型随机前瞻性试验结果相似。
Background. The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer.Methods. We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007.Results. Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p < .001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results.Conclusions. PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing.