Prostate Cancer Diagnosis and Treatment After the Introduction of Prostate-Specific Antigen Screening: 1986-2005
Prostate Cancer Diagnosis and Treatment After the Introduction of Prostate-Specific Antigen Screening: 1986-2005
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DOI：
10.1093/jnci/djp278
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发表时间：
2009-10-07
期刊：
影响因子：
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通讯作者：
Albertsen, Peter C.
中科院分区：
文献类型：
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作者：
Welch, H. Gilbert;Albertsen, Peter C.
尽管前列腺特异性抗原（PSA）筛查对前列腺癌死亡率的影响还不确定，但其对前列腺癌诊断率的影响几乎没有不确定性。然而，据我们所知，对受影响的男性人数的系统估计并不存在。我们从国家癌症研究所的监测、流行病学和最终结果项目中获得了年龄特异性发病率和初始治疗过程的数据。然后，我们使用美国人口普查中的特定年龄男性人口估计值来确定1986年后（PSA筛查引入前一年）每年诊断和治疗的男性人数的过剩（或不足），前列腺癌的总体发病率在1986年后迅速上升，在1992年达到峰值，然后下降，尽管水平比1986年高得多。然而，总体发病率掩盖了不同的年龄特异性模式：80岁及以上男性的相对发病率（2005年相对于1986年）为0.56，70-79岁男性为1.09，60-69岁男性为1.91，50-59岁男性为3.64，50岁以下男性为7.23。自1986年以来，估计又有1 305 600名男子被诊断患有前列腺癌，其中1 004 800人接受了明确的治疗。使用关于筛查益处的最乐观的假设-在此期间观察到的前列腺癌死亡率的整个下降可归因于这种额外的诊断-我们估计，对于每个经历了假定益处的男性，20多人被诊断为前列腺癌。PSA筛查的引入导致超过100万的男性被诊断和治疗前列腺癌在美国年轻男性的增长尤其引人注目。考虑到PSA筛查开始以来已经过去了相当长的时间，大多数这种过度发生率必须代表过度诊断。
Although there is uncertainty about the effect of prostate-specific antigen (PSA) screening on the rate of prostate cancer death, there is little uncertainty about its effect on the rate of prostate cancer diagnosis. Systematic estimates of the number of men affected, however, to our knowledge, do not exist.We obtained data on age-specific incidence and initial course of therapy from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. We then used age-specific male population estimates from the US Census to determine the excess (or deficit) in the number of men diagnosed and treated in each year after 1986-the year before PSA screening was introduced.Overall incidence of prostate cancer rose rapidly after 1986, peaked in 1992, and then declined, albeit to levels considerably higher than those in 1986. Overall incidence, however, obscured distinct age-specific patterns: The relative incidence rate (2005 relative to 1986) was 0.56 in men aged 80 years and older, 1.09 in men aged 70-79 years, 1.91 in men aged 60-69 years, 3.64 in men aged 50-59 years, and 7.23 in men younger than 50 years. Since 1986, an estimated additional 1 305 600 men were diagnosed with prostate cancer, 1 004 800 of whom were definitively treated for the disease. Using the most optimistic assumption about the benefit of screening-that the entire decline in prostate cancer mortality observed during this period is attributable to this additional diagnosis-we estimated that, for each man who experienced the presumed benefit, more than 20 had to be diagnosed with prostate cancer.The introduction of PSA screening has resulted in more than 1 million additional men being diagnosed and treated for prostate cancer in the United States. The growth is particularly dramatic for younger men. Given the considerable time that has passed since PSA screening began, most of this excess incidence must represent overdiagnosis.