Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis.
Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis.
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DOI：
10.1136/bmj.k3519
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发表时间：
2018-09-05
期刊：
影响因子：
--
通讯作者：
Dahm P
中科院分区：
文献类型：
--
作者：
Ilic D;Djulbegovic M;Jung JH;Hwang EC;Zhou Q;Cleves A;Agoritsas T;Dahm P
探讨前列腺特异性抗原（PSA）检测筛查前列腺癌的有效性和安全性。系统回顾和荟萃分析。电子检索Cochrane Central Register of Controlled Trials， Web of Science, Embase, Scopus, OpenGrey， LILACS和Medline，并检索科学会议摘要和试验注册到2018年4月。随机对照试验比较PSA筛查与常规护理在未诊断前列腺癌的男性。至少有两名审稿人筛选研究，提取数据，并评估合格研究的质量。一个平行的指南委员会（BMJ快速推荐）为系统评价的设计和解释提供了输入，包括对患者重要结果的选择。我们使用随机效应模型获得合并发病率比（IRR），并在可行的情况下，根据年龄、筛查频率、家族史、种族和社会经济水平进行亚组分析（先验定义），以及基于偏倚风险的敏感性分析。采用GRADE方法评估证据的质量。纳入了5项随机对照试验，共纳入721 718名男性。研究在筛查频率和间隔、活检的PSA阈值和偏倚风险方面有所不同。当考虑到所有证据时，筛查可能对全因死亡率没有影响（IRR 0.99, 95% CI 0.98至1.01；中等确定性），也可能对前列腺特异性死亡率没有影响（IRR 0.96, 0.85至1.08；低确定性）。对低偏倚风险研究（n=1）的敏感性分析也表明，筛查似乎对全因死亡率没有影响（IRR 1.0, 0.98至1.02；中等确定性），但对前列腺特异性死亡率可能有较小影响（IRR 0.79, 0.69至0.91；中等确定性）。这相当于在10年内每1000名接受筛查的男性中，死于前列腺癌的人数减少了1人。从纳入的试验中直接比较活检和治疗相关并发症的数据是有限的。通过建模，我们估计每1000名筛查的男性中，分别有大约1名、3名和25名以上的男性因败血症住院，因尿失禁需要护垫，并报告勃起功能障碍。在最好的情况下，前列腺癌筛查会导致10年内特定疾病死亡率的小幅下降，但不会影响总体死亡率。考虑基于PSA筛查的临床医生和患者需要权衡这些益处与筛查的潜在短期和长期危害，包括活检和后续治疗的并发症，以及过度诊断和过度治疗的风险。普洛斯彼罗注册号CRD42016042347。
To investigate the efficacy and safety of prostate-specific antigen (PSA) testing to screen for prostate cancer. Systematic review and meta-analysis. Electronic search of Cochrane Central Register of Controlled Trials, Web of Science, Embase, Scopus, OpenGrey, LILACS, and Medline, and search of scientific meeting abstracts and trial registers to April 2018. Randomised controlled trials comparing PSA screening with usual care in men without a diagnosis of prostate cancer. At least two reviewers screened studies, extracted data, and assessed the quality of eligible studies. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including selection of outcomes important to patients. We used a random effects model to obtain pooled incidence rate ratios (IRR) and, when feasible, conducted subgroup analyses (defined a priori) based on age, frequency of screening, family history, ethnicity, and socioeconomic level, as well as a sensitivity analysis based on the risk of bias. The quality of the evidence was assessed with the GRADE approach. Five randomised controlled trials, enrolling 721 718 men, were included. Studies varied with respect to screening frequency and intervals, PSA thresholds for biopsy, and risk of bias. When considering the whole body of evidence, screening probably has no effect on all-cause mortality (IRR 0.99, 95% CI 0.98 to 1.01; moderate certainty) and may have no effect on prostate-specific mortality (IRR 0.96, 0.85 to 1.08; low certainty). Sensitivity analysis of studies at lower risk of bias (n=1) also demonstrates that screening seems to have no effect on all-cause mortality (IRR 1.0, 0.98 to 1.02; moderate certainty) but may have a small effect on prostate-specific mortality (IRR 0.79, 0.69 to 0.91; moderate certainty). This corresponds to one less death from prostate cancer per 1000 men screened over 10 years. Direct comparative data on biopsy and treatment related complications from the included trials were limited. Using modelling, we estimated that for every 1000 men screened, approximately 1, 3, and 25 more men would be hospitalised for sepsis, require pads for urinary incontinence, and report erectile dysfunction, respectively. At best, screening for prostate cancer leads to a small reduction in disease-specific mortality over 10 years but has does not affect overall mortality. Clinicians and patients considering PSA based screening need to weigh these benefits against the potential short and long term harms of screening, including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment. PROSPERO registration number CRD42016042347.
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影响因子：
39.2
作者：
Gulati R;Gore JL;Etzioni R
通讯作者：
Etzioni R
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
DOI：
10.1056/nejmoa1801993
发表时间：
2018-05-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
--
影响因子：
7.2
作者：
Hultcrantz, Monica;Rind, David;Guyatt, Gordon
通讯作者：
Guyatt, Gordon
DOI：
10.1056/nejmoa1606221
发表时间：
2016-10-13
期刊：
The New England journal of medicine
影响因子：
--
作者：
Donovan JL;Hamdy FC;Lane JA;Mason M;Metcalfe C;Walsh E;Blazeby JM;Peters TJ;Holding P;Bonnington S;Lennon T;Bradshaw L;Cooper D;Herbert P;Howson J;Jones A;Lyons N;Salter E;Thompson P;Tidball S;Blaikie J;Gray C;Bollina P;Catto J;Doble A;Doherty A;Gillatt D;Kockelbergh R;Kynaston H;Paul A;Powell P;Prescott S;Rosario DJ;Rowe E;Davis M;Turner EL;Martin RM;Neal DE;ProtecT Study Group*
通讯作者：
ProtecT Study Group*