Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening.
Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening.
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DOI：
10.1001/jama.1993.03510080052031
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发表时间：
1993-08
期刊：
影响因子：
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通讯作者：
W. Catalona;Deborah S. Smith;T. Ratliff;J. Basler
中科院分区：
文献类型：
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作者：
W. Catalona;Deborah S. Smith;T. Ratliff;J. Basler
目的确定基于前列腺特异性抗原（PSA）的筛查是否改变了检测到的器官局限性前列腺癌的比例。设计一项前瞻性、非随机、基于PSA的系列筛选试验（随访6 ~ 37个月）和一个同期对照组。研究单位：一所大学中心的普通社区门诊筛查项目。研究组包括10,251名50岁及以上的男性（平均和中位年龄为63岁;接受活检的患者的平均和中位年龄为66岁），他们参加了前列腺癌筛查计划并同意接受静脉切开术。对照组由266名同时研究的相同年龄范围（平均和中位年龄，68岁）的私人患者组成，这些患者因直肠指检（DRE）异常而接受前列腺超声检查和活检。主要观察指标：检测到临床或病理学晚期前列腺癌的比例。结果男性被分为三组：对照组，基于PSA的初始筛查组，基于PSA的系列筛查组。检测到的临床或病理学晚期前列腺癌的比例如下：对照组，57%（27/47）;基于PSA的初始筛查组，37%（91/244）;基于PSA的系列筛查组，29%（37/129）。筛查患者的晚期癌症比例低于对照组（卡方2 [2] = 12.3; P = 0.002）;这种优势主要在70岁以下的患者中观察到。手术分期显示，未筛查组中有2.5%（1/40）的癌症在显微镜下呈局灶性且分化良好（可能是潜伏性癌症），初始筛查组中有2.9%（7/244），连续筛查组中有7.8%（10/129）（广义Fisher精确检验，P = 0.08）。结论：与通过单独评估异常DRE检测到的前列腺癌患者相比，基于PSA的筛查可以识别出一些具有显著增加的器官局限性肿瘤比例的前列腺癌患者。
OBJECTIVE To determine whether prostate-specific antigen (PSA)-based screening alters the proportion of organ-confined prostate cancers detected. DESIGN A prospective, nonrandomized, serial PSA-based screening trial (follow-up from 6 to 37 months), and a concurrent comparison group. SETTING General community outpatient screening program based at a university center. PATIENTS The study group consisted of 10,251 men aged 50 years and older (mean and median age, 63 years; mean and median age of patients who underwent biopsies, 66 years) who presented to a prostate cancer screening program and consented to phlebotomy. The comparison group consisted of 266 concurrently studied private patients in the same age range (mean and median age, 68 years) who were referred for prostatic ultrasonography and biopsy because of an abnormal digital rectal examination (DRE). MAIN OUTCOME MEASURE Proportion detected with clinically or pathologically advanced prostate cancer. RESULTS The men were divided into three groups: the comparison group, the initial PSA-based screening group, and the serial PSA-based screening group. The proportions of prostate cancers detected that were clinically or pathologically advanced were as follows: comparison group, 57% (27/47); initial PSA-based screening group, 37% (91/244); and serial PSA-based screening group, 29% (37/129). Screened patients had a lower proportion of advanced cancers than the comparison group (chi 2 [2] = 12.3; P = .002); this advantage was observed principally in patients younger than 70 years. Surgical staging revealed that the cancer was microscopically focal and well differentiated (possibly latent cancer) in 2.5% (1/40) of the nonscreened group, 2.9% (7/244) of the initially screened group, and 7.8% (10/129) of the serially screened group (generalized Fisher's Exact Test, P = .08). CONCLUSION Screening based on PSA identifies some men with prostate cancer who have a significantly increased proportion of organ-confined tumors compared with those detected through evaluation for an abnormal DRE alone.