Roberts R O, Bergstralh E J, Lieber M M, Jacobsen S J
Department of Health Sciences Research, Section of Clinical Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Urology. 2000 Nov 1;56(5):817-22. doi: 10.1016/s0090-4295(00)00790-1.
To assess the temporal trends in the prevalence of pre-biopsy abnormalities in digital rectal examination (DRE) findings, serum prostate-specific antigen (PSA) levels, and cancer detection rates by abnormality in all men from the community who had a prostate biopsy.
All Olmsted County, Minnesota residents who had their first prostate biopsy performed between January 1980 and December 1997 were identified (n = 1729). The complete medical records of these men were reviewed to determine the clinical findings at the time of the biopsy and the biopsy outcome.
The prevalence of an abnormal DRE decreased from 69% in 1980 to 1986 to 45% in 1993 to 1997 (P <0.001). The prevalence of an isolated elevated PSA level (normal DRE) increased from 28% in 1987 to 1992 to 42% in 1993 to 1997 (P <0.001). In men diagnosed with cancer, 55% had an abnormal DRE in 1993 to 1997 (P <0.001). Prostate cancer was detected in 471 (37%) of 1280 men with an abnormal DRE or elevated PSA level noted within 6 weeks of the biopsy. The positive predictive value for prostate cancer was 61% (229 of 373) in men with an abnormal DRE and elevated PSA, 34% (166 of 494) in men with an elevated PSA only, and 18% (60 of 327) in men with an abnormal DRE only.
The prevalence of an abnormal DRE at the time of biopsy has declined and that of an isolated elevated PSA has increased. However, nearly 40% of men with abnormalities in both PSA and DRE at the time of biopsy had a negative biopsy for prostate cancer. An increase in both the sensitivity and specificity of screening tests may further enhance the early detection of prostate cancer and potentially decrease the high negative biopsy rate.
评估社区中所有接受前列腺活检的男性在活检前直肠指检（DRE）结果异常、血清前列腺特异性抗原（PSA）水平以及按异常情况分类的癌症检出率的时间趋势。
确定了明尼苏达州奥尔姆斯特德县所有在1980年1月至1997年12月期间首次接受前列腺活检的居民（n = 1729）。查阅了这些男性的完整病历，以确定活检时的临床发现和活检结果。
活检时DRE异常的患病率从1980年至1986年的69%降至1993年至1997年的45%（P <0.001）。孤立性PSA水平升高（DRE正常）的患病率从1987年至1992年的28%增至1993年至1997年的42%（P <0.001）。在被诊断为癌症的男性中，1993年至1997年有55%的人DRE异常（P <0.001）。在活检后6周内DRE异常或PSA水平升高的1280名男性中，有471名（37%）检测出前列腺癌。DRE异常且PSA升高的男性中前列腺癌的阳性预测值为61%（373名中的229名），仅PSA升高的男性中为34%（494名中的166名），仅DRE异常的男性中为18%（327名中的60名）。
活检时DRE异常的患病率下降，而孤立性PSA升高的患病率上升。然而，活检时PSA和DRE均异常的男性中，近40%的前列腺癌活检结果为阴性。筛查试验的敏感性和特异性的提高可能会进一步加强前列腺癌的早期检测，并有可能降低高活检阴性率。
