The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA.
The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA.
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DOI：
10.1038/nrurol.2016.251
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Roobol MJ
中科院分区：
文献类型：
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作者：
Fleshner K;Carlsson SV;Roobol MJ
关于前列腺特异性抗原（PSA）筛查早期发现前列腺癌的建议，指南存在冲突。2008年，美国预防服务工作组（USPSTF）将75岁及以上的男性和2012年所有年龄段的男性分别评为D级（建议不进行筛查）。我们通过对2011年1月1日至2016年10月3日期间发表的关于PSA使用模式、前列腺癌发病率和活检模式变化的研究文献检索，回顾了2012年推荐前后筛查率的时间趋势，以及该推荐如何影响医生和患者对PSA筛查和随后安排其他筛查试验的态度。在所有年龄组和大多数美国地理区域内，PSA筛查率下降了3-10个百分点。前列腺活检率和前列腺癌发病率一致下降，并明显转向更高的分级、分期和检测风险。尽管有这样的建议，一些医生报告说，他们仍然愿意对适当选择的男性进行筛查，而且大部分男性报告说，他们打算继续要求进行PSA检测。在未来的几年里，我们期望对筛查率的降低是否会影响前列腺癌的转移和死亡率有一个更好的了解。
Guidelines conflict regarding recommendations for prostate-specific antigen (PSA) screening for early detection of prostate cancer. The United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men 75 and older in 2008 and for men of all ages in 2012. We reviewed temporal trends in rates of screening before and after the 2012 recommendation based on a literature search for studies published between 2011/01/01–2016/10/03 on PSA utilization patterns, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has shaped physician and patient attitudes about PSA screening and subsequent ordering of other screening tests. Rates of PSA screening decreased by 3–10 percentage points among all age groups and within most U.S. geographic regions. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a notable shift towards higher grade, stage and risk upon detection. Despite the recommendation, some physicians reported ongoing willingness to screen appropriately selected men, and men largely reported intending to continue to ask for the PSA test. In the coming years, we expect to have a better picture of whether these decreased rates of screening will impact prostate cancer metastasis and mortality.