Beemsterboer P M, Kranse R, de Koning H J, Habbema J D, Schröder F H
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Int J Cancer. 1999 Aug 20;84(4):437-41. doi: 10.1002/(sici)1097-0215(19990820)84:4<437::aid-ijc19>3.0.co;2-s.
A randomized screening trial was started in Europe to show the effect of early detection and treatment of prostate cancer on mortality (European Study on Screening of Prostate Cancer). In one centre (Rotterdam), the screening protocol initially consisted of 3 screening tests for all men: prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasonography (TRUS). A PSA value of >/=4 ng/ml and/or an abnormality on DRE and/or TRUS were taken to indicate that biopsy was required. In this study, we examined the possibilities for a more efficient screening protocol. A logistic-regression model was used to predict the number of cancers for PSA < 4 ng/ml if all men were biopsied (predictive index, PI). Effects of a change in PSA cut-off on the screening results were explored. Weights were applied to procedures and cancers to explore the possibility of expressing differences between protocols in one overall figure. Biopsies in men with PSA < 1 ng/ml and a positive DRE or TRUS were very inefficient. Applying DRE and TRUS only in the PSA ranges 1.5 to 3.9 and 2 to 3.9 ng/ml to determine whether a biopsy was required would result in a decrease of 29 to 36% in biopsies and a decrease of 5 to 8% in cancers. However, the results of DRE and TRUS could not be duplicated entirely. A protocol with only PSA >/= 3 ng/ml as a direct biopsy indicator resulted in a decrease of detected cancers by 7.6% and of biopsies by 12%, also a much simpler screening procedure. Use of the PI would give more efficient protocols, but this should be viewed as a preliminary finding, with the disadvantage of necessitating many additional screening visits. Since the results of DRE and TRUS could not be duplicated, a change in protocol towards PSA >/= 3 ng/ml appears acceptable. If this proves effective, a final judgement about the optimal combination of screening tests may be made. Int. J. Cancer (Pred. Oncol.) 84:437-441, 1999.
欧洲启动了一项随机筛查试验，以显示前列腺癌早期检测和治疗对死亡率的影响（欧洲前列腺癌筛查研究）。在一个中心（鹿特丹），筛查方案最初包括对所有男性进行3项筛查测试：前列腺特异性抗原（PSA）、直肠指检（DRE）和经直肠超声检查（TRUS）。PSA值≥4 ng/ml和/或DRE及/或TRUS异常被视为需要进行活检的指征。在本研究中，我们探讨了采用更高效筛查方案的可能性。使用逻辑回归模型预测如果对所有男性进行活检，PSA<4 ng/ml时的癌症数量（预测指数，PI）。探讨了PSA临界值变化对筛查结果的影响。对检查程序和癌症赋予权重，以探索能否用一个综合数字来体现不同方案之间的差异。对PSA<1 ng/ml且DRE或TRUS呈阳性的男性进行活检效率非常低。仅在PSA范围为1.5至3.9 ng/ml和2至3.9 ng/ml时应用DRE和TRUS来确定是否需要活检，将使活检数量减少29%至36%，癌症数量减少5%至8%。然而，DRE和TRUS的结果无法完全重复。仅以PSA≥3 ng/ml作为直接活检指标的方案使检测到的癌症数量减少了7.6%，活检数量减少了12%，同时也是一种更为简单的筛查程序。使用PI会得出更高效的方案，但这应被视为初步发现，并存在需要进行更多额外筛查的缺点。由于DRE和TRUS的结果无法重复，向PSA≥3 ng/ml的方案转变似乎是可以接受的。如果这被证明有效，或许可以对筛查测试的最佳组合做出最终判断。《国际癌症杂志（预测肿瘤学）》84:437 - 441，1999年。
