Serial prostate specific antigen screening for prostate cancer: A computer model evaluates competing strategies
Serial prostate specific antigen screening for prostate cancer: A computer model evaluates competing strategies
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DOI：
10.1097/00005392-199909010-00032
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发表时间：
1999-09-01
影响因子：
6.6
通讯作者：
Cowen, ME
中科院分区：
文献类型：
--
作者：
Etzioni, R;Cha, R;Cowen, ME
目的：我们比较前列腺特异性抗原 (PSA) 筛查策略的预期寿命年数、筛查次数、假阳性筛查次数和过度诊断率（定义为通过 PSA 筛查检测到未经筛查就永远不会被诊断的患者）。 材料和方法：使用了疾病进展、临床诊断、PSA 增长和 PSA 筛查的计算机模型。在基线条件下，当不考虑筛查时，该模型复制了 20 世纪 80 年代中期美国国家癌症研究所监测、流行病学和最终结果计划记录的临床诊断和疾病死亡率。结果：每年两次筛查，PSA 大于 4.0 ng./ml。预计相对于年度筛查，筛查和假阳性检测的数量将减少近 50%，同时保留 93% 的寿命。每年进行筛查时，会使用年龄特定的 PSA 界限来考虑测试呈阳性，而不是标准的 4.0 ng./ml。预计可将假阳性筛查减少 27%，将过度诊断减少三分之一，同时保留近 95% 的寿命。敏感性分析没有改变每年两次筛查的相对功效。结论：在模型假设下，每年两次 PSA 筛查是前列腺癌年度 PSA 筛查的一种经济高效的替代方案。与 4 ng./ml 的界限相比，每年进行 PSA 阳性年龄特定界限的筛查似乎可以显着减少假阳性结果和过度诊断率。同时保留大部分生存利益。
Purpose: We compare prostate specific antigen (PSA) screening strategies in terms of expected years of life saved with screening, number of screens, number of false-positive screens and rates of over diagnosis, defined as detection by PSA screening of patients who would never have been diagnosed without screening.Materials and Methods: A computer model of disease progression, clinical diagnosis, PSA growth and PSA screening was used. Under baseline conditions, when screening is not considered, the model replicates clinical diagnosis and disease mortality rates recorded by the Surveillance, Epidemiology and End Results Program of the National Cancer Institute in the mid 1980s.Results: Biannual screening with PSA greater than 4.0 ng./ml. was projected to reduce the number of screens and false-positive tests by almost 50% relative to annual screening while retaining 93% of years of life saved. With annual screening use of an age specific bound for PSA to consider a test positive instead of the standard 4.0 ng./ml. was projected to reduce false-positive screens by 27% and over diagnosis by a third while retaining almost 95% of years of life saved. Sensitivity analyses did not change the relative efficacy of biannual screening.Conclusions: Under the model assumptions biannual PSA screening is a cost-effective alternative to annual PSA screening for prostate cancer. With annual screening use of an age specific bound for PSA positivity appears to reduce false-positive results and over diagnosis rates sharply relative to a bound of 4 ng./ml. while retaining most of the survival benefits.