通过前列腺特异性抗原筛查检测出的前列腺癌若不进行诊断，会发展成临床癌症吗？瑞典两项基于人群的研究比较。

Would prostate cancer detected by screening with prostate-specific antigen develop into clinical cancer if left undiagnosed? A comparison of two population-based studies in Sweden.

作者信息

Hugosson J, Aus G, Becker C, Carlsson S, Eriksson H, Lilja H, Lodding P, Tibblin G

机构信息

Departments of Urology and Internal Medicine, Sahlgrenska University Hospital, G]oteborg, Sweden.

出版信息

BJU Int. 2000 Jun;85(9):1078-84. doi: 10.1046/j.1464-410x.2000.00679.x.

DOI:10.1046/j.1464-410x.2000.00679.x

PMID:10848699

Abstract

OBJECTIVE

To assess the risk of over-diagnosing and over-treating prostate cancer if population-based screening with serum prostate-specific antigen (PSA) is instituted.

PATIENTS AND METHODS

From a serum bank stored in 1980, PSA was analysed in 658 men with no previously known prostate cancer from a well-defined cohort from Göteborg, Sweden (men born in 1913); the incidence of clinical prostate cancer was registered until 1995. From the same area, and with the same selection criteria, another cohort of 710 men born in 1930-31, who in 1995 accepted an invitation for PSA screening, was also analysed.

RESULTS

Of men born in 1913, 18 (2.7%) had died from prostate cancer and the cumulative probability of being diagnosed with clinical prostate cancer was 11.1% (5.0% in those with a PSA level of < 3 ng/mL vs 32.9% in those with a PSA level of > 3 ng/mL, P < 0.01). The mean lead-time from increased PSA (> 3 ng/mL) to clinical diagnosis was 7 years. The prostate cancer detection rate in men born in 1930-31 was 4.4% (22% among those with increased PSA levels) and 30 of 31 detected cancers were clinically localized.

CONCLUSIONS

Screening and sextant biopsies resulted in a lower detection rate (22%) than the cumulative risk of having clinical prostate cancer (33%) in men with increased PSA levels, indicating that under-diagnosis rather than over-diagnosis is the case at least with 'one-time' screening. Even if the stage distribution in screening-detected cancers seems promising (and thus may result in reduced mortality) it is notable that screening 67-year-old men will result in treatment a mean of 7 years before clinical symptoms occur and only one in four men anticipated to develop prostate cancer will die from the disease within 15 years. Large randomized screening trials seem mandatory to further explore the benefits and hazards of PSA screening.

摘要

目的

评估采用基于人群的血清前列腺特异性抗原（PSA）筛查时过度诊断和过度治疗前列腺癌的风险。

患者与方法

从1980年储存的血清库中，对来自瑞典哥德堡一个明确队列（1913年出生的男性）的658名既往无前列腺癌的男性进行PSA分析；记录直至1995年临床前列腺癌的发病率。从同一地区，采用相同的选择标准，对另一队列710名1930 - 1931年出生且在1995年接受PSA筛查邀请的男性也进行了分析。

结果

在1913年出生的男性中，18人（2.7%）死于前列腺癌，临床诊断为前列腺癌的累积概率为11.1%（PSA水平<3 ng/mL者为5.0%，PSA水平>3 ng/mL者为32.9%，P<0.01）。从PSA升高（>3 ng/mL）到临床诊断的平均提前期为7年。1930 - 1931年出生男性的前列腺癌检出率为4.4%（PSA水平升高者中为22%），31例检出的癌症中有30例临床局限。

结论

筛查和六分区活检导致的检出率（22%）低于PSA水平升高男性临床前列腺癌的累积风险（33%），表明至少在“一次性”筛查中，存在诊断不足而非过度诊断的情况。即使筛查发现的癌症分期分布似乎有前景（因此可能降低死亡率），但值得注意的是，对67岁男性进行筛查会导致在临床症状出现前平均7年进行治疗，且预计每4名可能患前列腺癌的男性中只有1人会在15年内死于该病。大型随机筛查试验似乎是进一步探索PSA筛查利弊的必要手段。