A Model of Prostate-Specific Antigen Screening Outcomes for Low- to High-Risk Men Information to Support Informed Choices
A Model of Prostate-Specific Antigen Screening Outcomes for Low- to High-Risk Men Information to Support Informed Choices
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DOI：
10.1001/archinternmed.2009.282
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发表时间：
2009-09-28
影响因子：
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通讯作者：
Patel, Manish I.
中科院分区：
文献类型：
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作者：
Howard, Kirsten;Barratt, Alex;Patel, Manish I.
背景资料：信息是必要的，以帮助个人的决策有关前列腺特异性抗原（PSA）screening.Methods：我们的目的是提供这样的信息为男性年龄40，50，60，70岁，低，中，高风险的前列腺癌。马尔可夫模型比较了每年进行PSA筛查与不进行PSA筛查的患者，使用前列腺癌死亡率相对风险（RR）降低20%（RR = 0.8）作为最佳情况。该模型估计活检，前列腺癌，前列腺癌的死亡人数每1000人超过10年，并累积到年龄85 years.Results：利益和危害随年龄和家族风险有很大不同。以60岁的低风险男性为例，每年筛查1000名男性，我们估计115名男性将因PSA筛查结果异常而接受活检，53名男性将被诊断为前列腺癌超过10年，而1000名未筛查男性中有23名男性被诊断为前列腺癌。在接受筛查的男性中，3.5人将在10年内死于前列腺癌，而未接受筛查的男性中有4.4人死亡。对于1000名年龄在40至69岁之间接受筛查的男性，到85岁时将有27.9例前列腺癌死亡和639.5例死亡，而未接受筛查的男性中有29.9例前列腺癌死亡和640.4例死亡。高危男性有更多的前列腺癌死亡避免，但也有更多的前列腺癌诊断和相关harms.Conclusions：男性应被告知可能的好处和PSA筛查的危害。这些估计值可用于支持个人决策。
Background: Information is needed to aid individual decision making about prostate-specific antigen (PSA) screening.Methods: We aimed to provide such information for men aged 40, 50, 60, and 70 years at low, moderate, and high risk for prostate cancer. A Markov model compared patients with vs without annual PSA screening using a 20% relative risk (RR) reduction (RR = 0.8) in prostate cancer mortality as a best-case scenario. The model estimated numbers of biopsies, prostate cancers, and deaths from prostate cancer per 1000 men over 10 years and cumulated to age 85 years.Results: Benefits and harms vary substantially with age and familial risk. Using 60-year-old men with low risk as an example, of 1000 men screened annually, we estimate that 115 men will undergo biopsy triggered by anabnormal PSA screen result and that 53 men will be diagnosed as having prostate cancer over 10 years compared with 23 men diagnosed as having prostate cancer among 1000 unscreened men. Among screened men, 3.5 will die of prostate cancer over 10 years compared with 4.4 deaths in unscreened men. For 1000 men screened from 40 to 69 years of age, there will be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men. Higher-risk men have more prostate cancer deaths averted but also more prostate cancers diagnosed and related harms.Conclusions: Men should be informed of the likely benefits and harms of PSA screening. These estimates can be used to support individual decision making.