Neheman A, Shotland Y, Metz Y, Stein A
Dept. of Urology, Carmel Hospital, Lady Davis Medical Center, Haifa.
Harefuah. 2001 Jan;140(1):4-10, 88, 87.
Prostatic cancer (PC) is second only to lung cancer as a cause of cancer mortality in men word-wide. In Israel it is the most common cause of cancer mortality in men, after lung cancer and colo-rectal cancer. We screened, for the first time in Israel, for prostatic cancer using serum levels of PSA and a digital rectal examination (DRE). The purpose was not only to diagnose PC but also to increase public awareness of the condition. 300 men in the Haifa area who met statistical criteria for early diagnosis of PC participated. They filled a questionnaire regarding risk factors for PC (age, family history (FH) of prostatic and breast cancer, cigarette smoking, alcohol consumption, previous PSA sampling) and were examined. Those who had out-of-range, age-related PSA values, or a pathologic DRE underwent trans-rectal ultrasound (TRUS) examination and guided biopsy of the prostate. Those with a positive biopsy for PC underwent radical prostatectomy or radiation therapy. 41 (14.3%) had out-of-range, age-related PSA levels and 10 (3.5%) had a pathologic DRE. 39 (13.3%) underwent TRUS and biopsy and 6 (2.04%) had clinically significant PC, all early stages (Gleason 4-6). Correlation between age and PSA has been proven statistically significant (p < 0.05). Symptoms of urinary tract obstruction and nocturia were related to a high PSA (p = 0.035 and 0.002, respectively). Those with PC had at least 1 symptom of urinary tract obstruction; 6 (15.3%) who underwent TRUS and biopsy and a FH of prostate cancer. However, no subject with a FH of PC had biopsy-proven cancer. Those with PC had PSA values from 4.9 to 31.8 ng/ml (9.6 median). Age-related PSA had a positive predictive value of 17.1%. Results of our annual screening for early detection of PC using age-related PSA, and DRE are encouraging: cases detected were clinically significant and treatable. It would appear that screening for PC will result in decreasing the incidence of metastatic cancer and therefore mortality.
前列腺癌（PC）是全球男性癌症死亡的第二大原因，仅次于肺癌。在以色列，它是男性癌症死亡的最常见原因，仅次于肺癌和结直肠癌。我们首次在以色列使用血清前列腺特异抗原（PSA）水平和直肠指检（DRE）进行前列腺癌筛查。目的不仅是诊断前列腺癌，还提高公众对该疾病的认识。海法地区300名符合前列腺癌早期诊断统计标准的男性参与其中。他们填写了一份关于前列腺癌风险因素的问卷（年龄、前列腺癌和乳腺癌家族史（FH）、吸烟、饮酒、既往PSA采样情况）并接受检查。那些PSA值超出年龄相关范围或直肠指检结果异常的人接受了经直肠超声（TRUS）检查和前列腺引导活检。前列腺活检呈阳性的人接受了根治性前列腺切除术或放射治疗。41人（14.3%）的PSA水平超出年龄相关范围，10人（3.5%）直肠指检结果异常。39人（13.3%）接受了TRUS检查和活检，6人（2.04%）患有临床意义的前列腺癌，均为早期阶段（Gleason 4 - 6）。年龄与PSA之间的相关性已被证明具有统计学意义（p < 0.05）。尿路梗阻症状和夜尿症与高PSA相关（分别为p = 0.035和0.002）。患有前列腺癌的人至少有一种尿路梗阻症状；6人（15.3%）接受了TRUS检查和活检且有前列腺癌家族史。然而，没有前列腺癌家族史的受试者经活检证实患有癌症。患有前列腺癌的人的PSA值在4.9至31.8 ng/ml之间（中位数为9.6）。年龄相关PSA的阳性预测值为17.1%。我们使用年龄相关PSA和DRE进行前列腺癌早期检测的年度筛查结果令人鼓舞：检测出的病例具有临床意义且可治疗。似乎前列腺癌筛查将导致转移性癌症发病率降低，从而降低死亡率。
