Latest results from the UK trials evaluating prostate cancer screening and treatment: The CAP and ProtecT studies
Latest results from the UK trials evaluating prostate cancer screening and treatment: The CAP and ProtecT studies
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DOI：
10.1016/j.ejca.2010.09.016
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发表时间：
2010-11-01
影响因子：
8.4
通讯作者：
Donovan, J. L.
中科院分区：
文献类型：
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作者：
Lane, J. A.;Hamdy, F. C.;Donovan, J. L.
欧洲前列腺癌筛查随机研究(ERSPC)显示，前列腺癌特异性死亡率显著降低。正在进行的比较保护臂(CAP)分组随机对照试验(RCT)通过比较分配给一轮前列腺特异抗原(PSA)检测(干预)或标准临床护理的初级保健中心来评估前列腺癌筛查的有效性。英国8个地区的550多个中心(约45万名男性)被随机抽查(2002-2008年)。干预组参与者也有资格参加PROTECT(前列腺癌检测和治疗)RCT，评估局部前列腺癌的主动监测、放射治疗和根治性前列腺切除术治疗。在PROTECT中，从10,000多名前列腺癌患者中随机抽取了1500多名前列腺癌患者，这些患者来自诊所约111,000名PSA升高的患者。在子样本中对筛查的心理影响的调查显示，10%的男性在前列腺癌活检后3个月内仍经历高度痛苦(22/227)，尽管大多数人相对未受影响。PSA升高的前列腺癌风险较低，如果有尿路症状(频繁夜尿的优势比(OR)0.44，95%可信区间(CI)0.22~0.83)或活检前重复PSA降低20%(OR 0.43，95%CI 0.35~0.52)。45-49岁男性去PSA诊所就诊的频率较低(442/1299，34%)，癌症发现率为2.3%(10/442)。CAP和PROTECT试验(ISRCTN92187251和ISRCTN20141217)将有助于解决前列腺癌筛查的争论，确定局部疾病的最佳治疗方法，并产生改善男性健康的证据。(C)2010爱思唯尔有限公司。保留所有权利。
The European Randomised Study of Screening for Prostate Cancer (ERSPC) demonstrated a significant reduction in prostate cancer-specific mortality. The ongoing Comparison Arm for ProtecT (CAP) cluster randomised controlled trial (RCT) evaluates prostate cancer screening effectiveness by comparing primary care centres allocated to a round of prostate specific antigen (PSA) testing (intervention) or standard clinical care. Over 550 centres (around 450,000 men) were randomised in eight United Kingdom areas (2002-2008). Intervention group participants were also eligible for the ProtecT (Prostate testing for cancer and Treatment) RCT evaluating active monitoring, radiotherapy and radical prostatectomy treatments for localised prostate cancer. In ProtecT, over 1500 of around 3000 men with prostate cancer were randomised from over 10,000 with an elevated PSA in around 111,000 attendees at clinics. Investigation of the psychological impact of screening in a sub-sample showed that 10% of men still experienced high distress up to 3 months following prostate biopsies (22/227), although most were relatively unaffected. The risk of prostate cancer with a raised PSA was lower if urinary symptoms were present (frequent nocturia odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.83) or if a repeat PSA decreased by >= 20% prior to biopsy (OR 0.43, 95% CI 0.35-0.52). Men aged 45-49 years attended PSA clinics less frequently (442/1299, 34%) in a nested cohort with a cancer detection rate of 2.3% (10/442). The CAP and ProtecT trials (ISRCTN92187251 and ISRCTN20141217) will help resolve the prostate cancer screening debate, define the optimum treatment for localised disease and generate evidence to improve men's health. (C) 2010 Elsevier Ltd. All rights reserved.