Kranse R, Beemsterboer P, Rietbergen J, Habbema D, Hugosson J, Schröder F H
Department of Urology, Dijkzigt Academic Hospital, Rotterdam, The Netherlands.
Prostate. 1999 Jun 1;39(4):316-22. doi: 10.1002/(sici)1097-0045(19990601)39:4<316::aid-pros14>3.0.co;2-o.
In the European Randomized Study of Screening for Prostate Cancer (ERSPC, Rotterdam region), men aged 55-74 years are screened for prostate cancer by prostate-specific antigen (PSA) sampling, digital rectal examination (DRE), and transrectal ultrasound investigation (TRUS). All men with a PSA > or =4 ng/ml and/or a suspicious DRE and/or a suspicious TRUS are biopsied.
Logistic regression analysis was applied to derive a predictive index that equals the chance to find prostate cancer in a biopsy given the outcomes of the screening tests. This model was used to assess the number of cancers that could have been detected if all men had been biopsied (extrapolation). Furthermore, the model was used to study the possibilities for improvement of the current screening protocol.
PSA was the dominant predictor for prostate cancer in a biopsy, followed by prostate volume, DRE, and TRUS result. It is assessed that 69% (95% CI, 52-86%) of cancers that could be identified if all men were biopsied are currently detected. Application of the same methods to screening data obtained in Göteborg (the Swedish ERSPC partner) yielded almost identical results. It was found that, in the Rotterdam protocol, a considerable number of men were biopsied according to the screening protocol with an assessed lower chance to have prostate cancer than men who were not biopsied according to the protocol.
The chance to detect prostate cancer in a biopsy can be modeled quite accurately as a function of serum PSA, prostate volume, DRE, and TRUS results. Important improvements in the screening protocol can be achieved by the application of the predictive index.
在欧洲前列腺癌筛查随机研究（ERSPC，鹿特丹地区）中，对55至74岁的男性通过前列腺特异性抗原（PSA）采样、直肠指检（DRE）和经直肠超声检查（TRUS）来筛查前列腺癌。所有PSA大于或等于4 ng/ml和/或DRE可疑和/或TRUS可疑的男性均接受活检。
应用逻辑回归分析得出一个预测指数，该指数等于根据筛查试验结果在活检中发现前列腺癌的概率。此模型用于评估如果对所有男性进行活检可能检测到的癌症数量（外推法）。此外，该模型还用于研究改进当前筛查方案的可能性。
PSA是活检中前列腺癌的主要预测指标，其次是前列腺体积、DRE和TRUS结果。据评估，目前检测到的癌症占如果对所有男性进行活检可识别癌症的69%（95%CI，52 - 86%）。将相同方法应用于在哥德堡（瑞典ERSPC合作伙伴）获得的筛查数据，得到了几乎相同的结果。研究发现，在鹿特丹方案中，相当一部分男性按照筛查方案接受了活检，但其被评估患前列腺癌的概率低于未按该方案接受活检的男性。
活检中检测前列腺癌的概率可以根据血清PSA、前列腺体积、DRE和TRUS结果相当准确地建模。应用预测指数可实现筛查方案的重要改进。
